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I had severe painful headaches two times in my entire lifetime and both times I was in flight. I see some common factors in this two occurrences which I thought could be some known pattern so I would like to know if we can take precautions to avoid a headache.

The first time it happened to me in June 2007 while I was traveling from San Francisco to Newark. I clearly remember that I was in deep sleep and the crew member woke me up and asked me to open the blind as we were going to land soon. After opening the blind I was exposed to the sunlight and immediately I got a severe headache. It got settled just before the flight landed. I initially thought it could be due to tiredness, insufficient sleep and sudden exposure to sunlight from dark until a similar thing happened to me after 11 years.

The second time it happened to me was during my return flight last week (Jun 2018) from US to India; it was a connecting flight from Phoenix to London. Just a few (10-15) minutes before landing, the pilot started his announcement about the landing; I got this headache for a few minutes and it settled after a few minutes.

Trust me, when it happened the first time it was such a pain I never felt before in my lifetime and I got so scared that something bad is going to happen to me. The second time it was only a little better but very similar. Though I had traveled more than a couple of dozen times in between these two events, I experienced this only twice and I remember common factors in this two events

  1. Traveling from East-West.
  2. Moving to different timezone and at the destination it was dawning.
  3. Pilot announcement.
  4. Window seat.

Are there any patterns to it and can we take precautions?

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Your sinus passages were obstructed and it was atmospheric pressure squeezing your skull as the increasing pressure on the descent tried to equalize the pressure.

The air in your sinuses escapes much easier than it goes back in so the problem is always after a descent.

Feels like someone trying to drive a nail into your skull between your eyes. Plug your nose with your fingers with your mouth closed and blow GENTLY and you will feel the air enter your sinuses and relieve the pressure.

Good idea to take a sinus medication like Otrivin with your travel kit if you are having that problem regularly.

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    $\begingroup$ Good answer. I would add that there can be more than one nail and they can be distributed across your forehead and upper cheeks. $\endgroup$ – user1008090 Jun 23 '18 at 15:04
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    $\begingroup$ Yes depending on how many sinus cavities are blocked. Pressurization systems generally limit altitude changes to not more than 500 fpm, which most people can tolerate, but if they are blocked enough, even that is too much when pressure is increasing. You can have blocked sinuses without feeling like you have a cold. If I was going flying and although didn't have a cold I suspected my sinuses were congested, I'd sometimes take a Sudafed (no side effects for me), and I could almost feel with wind flowing around the little galleries in my head, the passages were so open. $\endgroup$ – John K Jun 23 '18 at 18:08
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    $\begingroup$ This phenomenon is described as a "Sinus Block" here: webapp1.dlib.indiana.edu/virtual_disk_library/index.cgi/4300833/… $\endgroup$ – Zoltan Jun 23 '18 at 21:28
  • $\begingroup$ Strange how many people have experience about nails in the skull ;-) $\endgroup$ – Paŭlo Ebermann Jun 24 '18 at 23:29
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    $\begingroup$ Just note: if you try to gently blow/push air into your nose while holding your nostrils and you don't feel air rushing back into your sinuses, don't push harder. It's likely you have a blocked sinus from a cold or infection. In this case you'll have to suffer through the 'headache' when landing and wait for your sinuses to equalize normally, or take a sinus medication after landing. $\endgroup$ – Robotnik Jun 25 '18 at 1:34
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All in all, sounds like an equalization issue. Descending in an aircraft the whole way is about equivalent to diving 10 feet. That's not a lot, but it's enough that you'd equalize once or twice.

When you feel the characteristic pressure difference (a dull feeling in your head), equalize, either with a nose pinch or with Valsalva (similar to swallowing with your mouth closed).

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