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4 Simple Steps to Avoid Headaches While Flying
As if plane travel itself isn't enough of a headache, researchers have detected a distinctive pain pattern at 35,000 feet. If you notice a pattern of headaches while flying, you're not alone. As a Million Mile flyer whose advocacy work requires a lot of plane travel, I find it a personal challenge. Here's what I've learned about why an airplane headache happens. Discover what you can do to prevent a headache while flying — before you book your next trip.
Are Airplane Headaches a Real Thing?
A headache when flying, also known as "headache attributed to airplane travel," can occur during takeoff and landing as the plane changes altitude.
Flying is also a migraine trigger for many. "In many headache clinics, people with migraine often report that their attacks are exacerbated by air travel," said Andrew Charles, MD, director of the Goldberg Migraine Program at UCLA and president-elect of the American Headache Society. "The interesting question is whether it's the change in barometric pressure or the change in oxygenation that triggers pain. It is known experimentally that low oxygen levels are a migraine trigger, but there is also a notion that even if you didn't change oxygen levels, changing barometric pressure is also potentially a migraine trigger. It may, therefore, be either one of those, or both in combination, that are responsible for causing high altitude headache and migraine."
The Difference Between an Airplane Headache and a Migraine Attack
Even though headaches while flying are not always the same as migraine attacks, it can be difficult to tell the difference at first, especially when you're in pain and stressed. But, fundamentally, the cause and the symptoms of an airplane headache are different from those of migraine.
During a migraine attack, head pain is often just one of several symptoms. Your migraine head pain is more likely to be on one side of your head, behind your eye, and is caused by a genetic neurological response in the brain to your personal triggers.
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Some of those biggest migraine triggers include stress, dehydration, dry air, strong odors, alcohol, foods with nitrites — all things we can be exposed to during the air travel experience.
Airplane headaches can also be severe, one-sided, and are usually located behind the eye. The pain intensity can be great and the pain is often stabbing. Sounds like a migraine, right?
The difference is an airplane headache will worsen when the plane ascends or descends, and they typically resolve within 30 minutes of takeoff or landing. That makes airplane headaches much shorter than a typical migraine attack, which often lasts hours or even days.
Bui SBD, Gazerani P. Headache attributed to airplane travel: diagnosis, pathophysiology, and treatment - a systematic review. J Headache Pain. 2017;18:84.
Bui SBD, Petersen T, Poulsen JN, Gazerani P. Simulated airplane headache: a proxy towards identification of underlying mechanisms. J Headache Pain. 2017;18:9.3).
Mainardi F, Lisotto C, Maggioni F, Headache Attributed to airplane travel (‘airplane headache’): Clinical profile based on a large case series. Cephalalgia, 2012; 32:8.
That's in contrast to migraine, which affects three times as many women as men.
Airline Accommodations to Help Prevent Headaches While Flying
While there's a lot we can do to prevent an airplane headache or a migraine attack while flying, airlines have a vested interest in making the flight experience less painful. After all, how many people want to fly an airline if they associate it with painful attacks?
Among the triggers within an airline's control: optimizing light, sound, and offensive odors; offering healthy food and drink options; supporting passenger hydration; offering ice bags, earplugs, and eye masks; stabilizing cabin pressure changes; and ensuring flight attendant training. Some airlines do a better job than others with healthy food options and walking the aisles with water cups every 30 to 60 minutes.
Still, cabin lighting, jet engine sound, and food odors cannot be individually controlled, as I experienced on a recent Delta cross-country flight. With no way to dim the cabin lights or diffuse the nauseating combination of hot chicken and the lavatory, it was pure misery.
Treating an Airplane Headache or In-Flight Migraine Attack
Doctors advise that an airplane headache is best treated with either a nonsteroidal anti-inflammatory drug or a triptan that you've packed in your carry-on bag. Obviously, airlines don't stock them. For years, I wouldn't take off without an injectable sumatriptan syringe in my carry-on for migraine attacks, often discreetly administered in an airplane bathroom. Today, sublingual medication or nasal sprays are good options when you need relief quickly.
Ice or heat, supplemental oxygen, water, blankets, and pillows can provide additional comfort in midair and are a flight attendant call button away.
Delva I, Delva M: Successful Treatment of Airplane Headache with Rizatriptan: Case Report. Case Rep Neurol 2021;13:375-379
4 Simple Steps to Avoid Headaches When Flying
Step 1 — Schedule Wisely
While it may be tempting to choose that less expensive red-eye or 6 a.m. flight, it's possible you'll pay for it later. Sleep disruption may not affect an aviation headache, but it's a commonly reported trigger for migraine and could increase your odds of a headache while flying. The money you save on the cheaper flight could cost you more in pain medication and lost wages later.
Changing time zones is especially difficult, which I do often as I fly coast to coast and cross oceans to attend medical conferences and advocate for people with migraine. Now I avoid scheduling early-morning meetings when I travel west to east and drink Sleepytime tea with a melatonin tablet on the first night of arrival. It has no effect on airplane headaches but reduces the chance that inconsistent sleep patterns will trigger a migraine attack the next day.
"Sleep routine is critically important for migraine sufferers. [Inconsistent sleep is] quite damaging ... for a person with migraine it can actually provoke more headaches" explained Toronto headache specialist Christine Lay, MD, in our "Migraine Again Podcast" interview.
If you can't avoid red-eye flights, which are common for cross-oceanic trips, wear comfortable clothes and pack a neck pillow, comfy socks, eye mask, and earplugs. Skip the in-flight movie, too. Dr. Lay advised: "Avoid light-emitting screens for a couple of hours before bedtime."
Step 2 — Stock Your Carry-On
To prepare yourself for a possible in-flight airplane headache, pack the medication your doctor recommends (such as ibuprofen or triptans) and an empty reusable screw-top ice pack that will go through security. Those will come in handy if you happen to have a migraine attack as well.
If you are prone to migraine attacks, you'll want to stock your carry-on with sunglasses, eye masks, earplugs, or noise-canceling earphones (worth every penny!), a healthy snack, and an empty water bottle you can fill before boarding and after security. Since I can get nauseated from strong odors, I also pack a lavender stick and anti-nausea medication.
Many of these items are available to purchase in the terminal if you forget them at home.
Step 3 — Know What to Eat and Avoid Preflight
The day before you fly is the time to start avoiding migraine-triggering foods and drinks like alcohol, processed foods with MSG and nitrites, and anything else you're sensitive to. Veteran cross-country flyer Kristin Chenoweth spends her time jetting between New York and Los Angeles for stage and screen work. In her 2019 Migraine World Summit live event interview, she offered a personal tip that's helped her avoid a headache while flying: "Pound the water, people!"
Managing hydration levels cannot be understated. Drinking plenty of water the day before the flight, during flight, and after you land is recommended by frequent travelers and physicians. Staying well hydrated could go a long way in preventing a headache while flying.
Moawad, Heidi. Airplane Headaches: What the Research Says. Neurology Times. 2018 February
Step 4 — Settle In and Manage Your Ride
Now you've chosen a conveniently timed flight, packed your carry-on carefully, and pounded the water before boarding. It's time to settle in with everything easily accessible at your feet.
To manage your ride, you'll want to avoid sleeping in flight unless you're changing time zones and you need to adjust. "Naps aren't advisable for people with migraine," advised Lay in her interview.
Turbulence is something you simply cannot anticipate but which can elevate migraine-triggering anxiety in addition to making you queasy. If this is a common issue for you, ask your doctor for the best anti-nausea solution for you or drink a beverage that can help ease your nausea quickly. Some anti-nausea medications can also help alleviate a migraine attack if taken early in your attack.
If you're not nauseous and feel like eating, choose one of the healthier options offered by the airline. Look for nutrient-rich foods with magnesium, omega-3s, and riboflavin that are not only good for you but also can help prevent migraine attacks.
Should you still struggle with in-flight headaches or migraine attacks after trying these four steps, see your doctor to brainstorm solutions.
Do you ever get headaches when flying? Does plane travel trigger a migraine attack for you? Share your prevention tips on Tippi.
