Ask Captain Lim

Hello Capt Lim,

Some years ago, I experienced a terrible headache on board an airplane. It started between 35 or 45 minutes after take off when the plane reached its highest cruising altitude. Then suddenly I began to feel an incredible headache that made me feel very ill. At that moment, I had to take an aspirin but it wasn't enough to stop it once it had started . The pain was so horrible that I thought I was going to die or that my head would explode. It was like as if someone was piercing needles between my eyes and nose and had an inflated air bag placed within my head.

The doctor told me it was a problem of hyperventilation and that it may be caused by high pressure in the airplane. This also happened to me whilst flying to the Canaries Island by Iberia and Sweden by Spanair or SAS. I remembered one of the Flight Attendant was so shocked to see me in such a condition that she went to check if the air pressurization system was working normally on the plane at that time.

However, I do not always suffer from this problem during all my flights and I came to the conclusion that this could be happening to me because of the altitude of airplane. Obviously, it was me that was having this physical problem as the rest of the passengers were fine.

Nevertheless, do you think that this problem may also be aggravated by an incorrect working pressurization system? Do you think the different altitude of the flight could affect the gravity of the problem? Have you heard of someone else with a similar problem as mine?

Fortunately after a doctor had told me to take a pill 20 minutes before taking off, I never had this problem again. . Best regards, Jose

Hi Jose, Your problem sounds more like a case of sinusitis rather than hyperventilation. Do you know that your head has many small cavities? Yes, they are found in the four sinuses above your eyes, behind the forehead; side of the nose below the eye; between the eyes; back in the head, far behind the nose and above the throat. Too many areas within your head! These sinuses are connected to the nose. Sinusitis refers to any inflammation or irritation of the sinus. These arose because of bacterial infection or due to a cold that you may have.

Now when you are on the ground, the air pressures in these cavities are filled with sea level air of about 15 psi (pounds per square inch). If you have sinusitis, these cavities which are connected to the nose may be closed due to inflammation. To make it simple for me to explain, think of an air-filled helium balloon. When released, it climbs up into the air. As it climbs, the air pressure in the atmosphere outside reduces. This causes the higher pressure in the balloon to expand until a point when it will burst.

Similarly, during the climb, the air pressure in the cavities are not able to escape at the normal rate, hence causing great pain in your case. The pain which comes from pressure on the membranes is usually above the nose and between the eyes where the sinuses are located. Often the most severe pain comes when a vacuum is formed. It is like having a 5 pound weight on your eyeball!

An airplane may climb up to about 35,000 feet but the cabin altitude is 'artificially maintained' to a cabin altitude of around 8,500 feet only. This is to reduce the differential pressure in your cabin environment.

So the cause of any pain is due to lower cabin pressure when the airplane climbs and not due to higher pressure as claimed by your doctor. He was probably referring to the other scenario when you would encounter higher pressure as the airplane descends. This can also trigger pain caused by the opposite effect.

What is the treatment? Well, it consists of opening the sinus passages so the air pressure can equalize. This is usually done by spraying the nose with a nasal decongestant. The doctor may give you cortisone by injection or pill to get the passages open.

The sinus problem is not due the pressurization of the airplane because it is carefully maintained and monitored throughout the flight. So the problem is yours. Yes, others with sinusitis would also encounter the similar problem as yours. So you are not alone in this world who feel such pain in the air in flight. For your information, there are about 35 million people in the US with sinusitis.