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Old 24th Jan 2008, 12:05   #1 (permalink)
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Extreme pain in forehead during descent/landing

Want't to hear if any one out there has had any similiar problems. Since June last year I keep having extrem pain in my forehead, and moore to the left side of it during descent/approch fase. This rarely happens when I fly bigger machines like B737/MD80 but almost always happens in RJ200/BAe146/Fokker 50, since June last year.

I do fly a lot in my job, and this is really among the worst pains I've ever experienced. It all started in June. I am completly healthy except for this, and I even have tried to overspray before takeoff/approach with Nezeril/Otrivin (nose spray, don't know the proper word for it as I'm not english speaking by native).

Today I changed flight in Denmark but couldn't continue on to the next leg, I was in such disgustful pain so I had to cancel mid-way and fly back home. Any ideas is greatly appreciated.

Last edited by Simon10; 24th Jan 2008 at 12:09. Reason: missing words
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Old 24th Jan 2008, 12:42   #2 (permalink)
 
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Sounds like a bit of air stuck in the frontal sinus cavities.


Probably worth a check out with the quack to rule anything obvious out, but it does sound like your symptoms are related to pressure changes. (Ever seen them bread roll wrappers blow up at altitude-simillar effect in the tubes running through your skull.)

Probably worth an ent consult and maybe a scan, especially considering the nature of your job.

Last edited by gingernut; 24th Jan 2008 at 13:16.
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Old 24th Jan 2008, 12:56   #3 (permalink)
 
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I've had exactly the same pain when flying in unpressurised freighters on the descent phase. Something like a handful of hot needles rammed into my forehead. As you say, it's incapacitating. Blocked sinuses in my case.
Caused by the rate of descent (and pressurisation settings in passenger aircraft).
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Old 24th Jan 2008, 13:15   #4 (permalink)
 
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Had a similar problem many moons ago, was told by doc to try a nasal strip and see if it helped, worked wonders, this led to having my sinus's cauterised and never had the problem again.
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Old 26th Jan 2008, 17:50   #5 (permalink)
 
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yep i got that, i initially thought it was barodontalgia (to do with teeth), but after a visit to my GP before i flew to europe for a holiday (i'm going home tomorrow , great skiing i must say!)

He told me that it was barotrauma with my sinus (most likely), and to take a sudafed (cold and flew pill) starting about 24 hours before my flight, however, i really only took the sudafed about an hour before the descent..

i'm not sure if it was just a phase that i had, i'm not sure if the sudafed fixed it, but loaded with sudafed it never seemed to come!
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Old 26th Jan 2008, 20:01   #6 (permalink)
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Thank you all for your replies. In some way it feels good to know that I'm not the only one with this problem, however of course I'm not happy that others are suffering too... a great paradox I assume.

However, yesterday I went to see a ENT-specialist who by camera (or a small snake-looking devise) could see that the passage through the nose to the sinuses was swollen. So now I'm on cortison for six-months (!!!!!!) and some other kind of medication (de-swollowing). Sorry for my crap english medical terms. Tuesday I'm of to Paris and I am very curious/apprehensive on to what to expect when we start to descent...

Once again, thank you for taking your time to reply on my issue.
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Old 26th Jan 2008, 21:51   #7 (permalink)
 
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good to know

having swollen passages means the smallest amount of mucus/snot being caught in there can dry and block it, being the cause of the problem due to the air expanding on descent and not being released.
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Old 27th Jan 2008, 09:36   #8 (permalink)
 
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Simon, seem a reasonable course of action, if the steroids are administered via a spray, don't expect instant results. (they'll probably take a few weeks to kick in).
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Old 27th Jan 2008, 16:24   #9 (permalink)
 
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Your idea about this being related to your sinuses is a good one. Buy some decongestant nose drops from your local pharmacy. Next time you fly sniff one drop up each nostril 30 minutes before take-off and 30 minutes before descending. This should open the sinuses and prevent the pressure build up.

Hope this helps
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Old 27th Jan 2008, 17:03   #10 (permalink)
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The problem with taking decongestants or flying with blocked sinuses is not simply the present pain or the pain relief; it is the subsequent consequences.

In the climb, as the cabin pressure reduces there will be a buildup of pressure in both the sinus and the inner ear. Both should vent naturally into the nasal passages. Any inflamation or congestion will then reseal the passages - you will feel stuffed up etc.

When the aircraft descends the pain will first be noticeable in the ears as external pressure on the tympanic membrane will cause pain and ultimately it might burst. You will not necessarily the sinus as the sinus cavity is surrounded by bone.

Now a decongestant will undoubtedly open up the eustachian tubes and allow pressure equalisation and also in the sinus cavities. Unfortunately there is an excellent chance that the gunge that closed the tubes in the first place, an excellent design feature, will get into the sinus cavity and the inner ear leading to infection and potentially deafness.

The moral? Don't fly with blocked sinus or a sever cold!
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Old 1st Feb 2008, 13:17   #11 (permalink)
 
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Excruciating pain

I'm so glad it's not just me.
EVERY time I fly (but on descent only) I experience excruciating, crippling pain in my head, face, ears, and even down my neck. It feels as if my head is going to explode with the pressure.
The only thing that relieves it is Max strength Sudafed - and lots of it. I start taking it an hour before the plane is due to land. I know this isn't good for me, and I am certainly not suggesting this to anyone else, but believe me I would take anything, in any quantity to get rid of the pain. You have to experience it to believe it.
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Old 1st Feb 2008, 13:20   #12 (permalink)
 
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..... another tip

Someone also once told me to massage the space between the little finger and ring finger. Whether the worst had passed by the time I started to do this in desparation, or not, it seemed to help.
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Old 1st Feb 2008, 14:20   #13 (permalink)
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PE, pain killers are not the answer. You have two choices. Walk or medical.

The sinus is an obvious pain point especially as its drain point was designed for quaudripeds and not bipeds. This is why, after swimming, when you bend over water streams from your nose.

Another pain point and one which clears less easily are cheekbone cavities. Ear ache of course is by failure to clear your eustachion tubes.

Basically from what you have said you need urgent instruction in aviation medicine. There is a simple, and I am sure painless procedure to have the various passages reamed out so that they do not block.

You need to read up about the various baratraumas and ring NHS Direct. I suggest NHSD as it will give them time to read up or find a suitable expert. Your GP, unless you hit lucky, will know little more than you do. NHS D may then suggest surgery.
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Old 15th Mar 2008, 21:08   #14 (permalink)
 
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I don't fly for a living but this has happened three times to me in the past. Yes, one of the most painful expieriences of my life! I'm flying to Paris in a week and am getting paranoid about it happening then. What i'm hoping will work for me is taking sudafed and also inhaling tree tea oil.

Good luck.
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Old 15th Mar 2008, 21:32   #15 (permalink)
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James,

How often has this happened? Everytime you fly or sometimes when you have flown?

Did have, or had you had a cold before you flew?

Had you been swimming?

If it has been only occasional, if you don't have a cold, and if you can easily clear your ears, then you should not have a problem.

Clearing ears and clearing sinuses is not the same thing but it is indicative of a problem or not.

There are several ways of clearing ears. Traditionally it was sucking a barley sugar during climb and descent. Alternatively waggling your jaw. Best, IMHO, is hold your nose and then gently increase the pressure in left nostril until that eardrum pops then repeat with the right. It may take practise but it is so long ago when I first did it .
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Old 15th Mar 2008, 21:43   #16 (permalink)
 
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Hi,

This happened at all sorts of different times. First time was a flight to Geneva but on the return flight i was fine. Second was when i was flying a grob tutor and third time was flying to turkey but on the return flight i was fine . I had done some flights in between those and i was fine too. I did have a cold on two of the occasions but when i flew to turkey i didn't think i had a cold until then lol.

Thanks for advice.
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Old 15th Mar 2008, 21:45   #17 (permalink)
 
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And no, i hadn't been swimming lol.
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Old 15th Mar 2008, 21:59   #18 (permalink)
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No worries then.
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Old 16th Mar 2008, 08:20   #19 (permalink)
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I saw an ENT-doctor late January due to severe pain in my forehead during descent. Since then I got a steroids administered through nasal spray for use twice daily. Furthermoore I got the following instruction before going onboard a flight:

=>90 min. before takeoff 1 sudafed pill for anti-swolling
=>30 min. before takeoff 2 x showers in each nostril with Otrivin Decongestant Nasal Spray
=> immediately before take off: 1 x shower in each nostril with Otrivin
=> immediately before descent: 2 x showers of Otrivin in each nostril

This has helped me during all 7 of 8 flights since I started treatment. However, during one of the 8 flights I got back the pain in my forehead and immediately used lot's of nasal spray, which eased the pain to a bearable level.

I realize that this of course is not an long term solution and I most probably need to fix this problem by surgery. Foremost because using that much nasal spray is not good and one is at risk of developing a chronic nasal congestion.

Please, please..., don't apply this treatment on our your self before discussing with you doctor as It is only a personal recommendation.
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Old 16th Mar 2008, 23:56   #20 (permalink)
 
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I suggest not using NHS direct, you will not get any sensible replies!

Option 1. Use Otrivine 30 mins before take-off. Quick fix, will work in many cases, however long term use will your nasal septum to erode. Not a permanent solution

Option 2. Work out what is actually wrong. Do you get hayfever/ allergy symptoms? Are your symptoms seasonal? Are you allergic to house dust/ pets etc? If so steroid sprays are likely to help. Modern sprays can give relief within 3 days, and some can be bought over the counter (eg Flixonase).

Option 3. Do it properly. See a GP, take their advice, and if things don't settle ask to be referred to an ENT surgeon. Before being considered for surgery decongestants and steroids will be tried, and a CT will be performed to check that your problems can be helped with surgery (not all can). The surgery involved is called FESS (functional endoscopic sinus surgery) - like all surgery it isn't without risk, the frontal sinuses are a tad close to the brain & the eyeballs! It has sorted out many professional pilots though.

Be careful taking decongestant tablets if flying, many are sedating & have been documented to cause CFIT.......

The pressure changes that develop in the ear in flying are not usually enough to cause permanent damage (unlike diving), but will disable & you certainly shouldn't be in control of a plane if you can't equalise or are getting distracting sinus pain.
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