Headache Attributed to Aeroplane Travel: An Historical Outline

INTRODUCTION: Headache attributed to aeroplane travel (AH) is one of the new nosological entries in the International Classification of Headache Disorders (ICHD) 3 beta. MATERIALS AND METHODS: This study retraces the history of headache related to flight, from the initial description to the modern reports, on the basis of original sources. RESULTS: Head pain related to flight has been reported since the beginning of flight era. However, most of those early cases are easily recognized as secondary to an exceptional barotrauma and/or a sinusitis concomitant with the flight. Instead, contemporary research identified a new nosological entity, AH, which by definition occurs in normal flying conditions and in absence of any sinus pathology. Moreover, we identified recently similar forms of headache, triggered by sudden changes of external pressure (rapid descent from mountain, mountain descent headache, MDH); and ascent from diving, diving ascent headache (DAH). CONCLUSION: Head pain related to flight has been reported since the origin of aviation, but it was caused by an exceptional barotrauma or a respiratory infection. Instead, AH occurs in normal flying conditions. Two newly identified conditions, MDH and DAH, appear to share a common pathogenetic mechanism with AH: namely the imbalance between intrasinusal and external air pressure. Therefore, we assert that an expansion of this entity of AH is something that should be considered in the next ICHD.