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Headache and Decompression Sickness: Type I or Type II? Major L. Michelle Bryce DO, MTM&H Colonel William P. Butler MD, MTM&H USAF School of Aerospace Medicine Building 775 2602 West Gate Road Brooks AFB, TX 78235-5252, USA Colonel (retired) E. George Wolf MD, MPH Larry Krock PhD Davis Hyperbaric Laboratory USAFSAM/FEH 2602 West Gate Road Brooks AFB, TX 78235, USA Hollis King DO, PhD Osteopathic Manipulative Medicine Western University of Health Sciences 309 E. 2 nd St. Pomona, CA 91766, USA Andrew A. Pilmanis PhD Air Force Research Laboratory 2504 Gillingham Drive, Suite 25 Brooks AFB, TX 78235, USA Decompression Sickness (DCS) results from exposure to reduced environmental pressure. As a result, excess nitrogen evolves from tissues. This gas may then form bubbles that may localize in tissue or vessels. They then create symptoms that range from mild to severe. Commonly, mild symptoms are joint pains and are called Type I DCS. Severe symptoms can run a range of neurological manifestations and are called Type II DCS. Treatment for Type I may only require ground level oxygen, while Type II necessitates recompression with 100% oxygen (7). Headache associated with DCS is not new. Ryles and Pilmanis reported an eleven-year period from the Armstrong Laboratory at Brooks Air Force Base, Texas. Out of 447 subjects, 0.9% reported headache (14). The German Air Force experience during World War II reported a 2.0% incidence rate (3). Bason searched the US Navy in-flight and altitude chamber experience. His incidence rates were 6.7% and 8.6% respectively (1,2). The basis for this paper stems from two cases seen in the Davis Hyperbaric Laboratory and Air Force Research Laboratory at Brooks Air Force Base, Texas. This then prompted a review of headache DCS in the USAF. The traditional view has always been that a headache associated with DCS must be serious, Type II, or neurologic DCS. Yet in many cases there is no associated neurological symptoms. This begs the question, should headache always be considered Type II DCS? This paper will propose an alternative view. Case 1 A twenty-one year old female was an altitude research protocol subject. She received no oxygen pre-breathe and subsequently went to 22,500 feet on 100% oxygen. She then developed an occipital headache at 135 minutes into the protocol. On return to ground level, she was nauseous with mild tenderness over the occipital suture. Her detailed neurological exam was normal. Recompression with 100% oxygen produced relief within fifteen minutes. Follow up revealed no recurrence. Case 2 A twenty-seven year old female was an altitude research protocol subject. Her altitude chamber flight to 35,000 was uneventful. Nine hours later she developed a left lateral orbital headache. She did not present for evaluation and the next morning awakened symptom free. She then participated in another chamber flight to 43,000. Two hours later she developed the same left orbital headache. On evaluation she had mild discomfort to palpation over the left orbit yet no sinus tenderness. A detailed neurological exam was normal. She was given 100% oxygen, without recompression, and experienced relief in 45 minutes. Follow up revealed no recurrence. Both cases pose an intriguing question. Should headache always be considered Type II DCS? DCS has a wide range of symptoms. This makes it difficult to diagnose and frequently can result in un- Paper presented at the RTO HFM Symposium on “Operational Medical Issues in Hypo- and Hyperbaric Conditions”, held in Toronto, Canada, 16-19 October 2000, and published in RTO MP-062. 2-1
Page 1 and 2: RTO-MP-062 NORTH ATLANTIC TREATY OR
Page 3 and 4: NORTH ATLANTIC TREATY ORGANIZATION
Page 5 and 6: Operational Medical Issues in Hypo-
Page 7 and 8: Contents Executive Summary iii Synt
Page 9 and 10: Respiratory Changes and Consequence
Page 11 and 12: Introduction Technical Evaluation R
Page 13 and 14: In addition to cabin pressurisation
Page 15 and 16: critical. The so-called technical d
Page 17 and 18: levator veli palatini, like when sw
Page 19 and 20: Present and Future Compromises in A
Page 21 and 22: KN1-3 (RGE) as the safety criterion
Page 23 and 24: Pulmonary Barotrauma KN1-5 Free ven
Page 25 and 26: KN1-7 Future fighter aircraft may w
Page 27 and 28: KN1-9 Figure 1 Cabin Pressurisation
Page 29 and 30: KN1-11 Figure 3 The relationships b
Page 31 and 32: +\SHUEDULF 2[\JHQ $ 6FLHQWLILF 8SGD
Page 33 and 34: KN2-3 recovers spontaneously withou
Page 35 and 36: KN2-5 Hg or less. The attendant hyp
Page 37 and 38: KN2-7 8 Tompach PC, Lew D, Stoll JL
Page 39 and 40: USAF Experience with Hyperbaric The
Page 41 and 42: Exposure Results and Discussion The
Page 43 and 44: Symptomotology Symptom presentation
Page 45 and 46: Air Force Altitude DCS Treatment Al
Page 47: References 1. Atlas of Injuries in
Page 51 and 52: Numerous studies have been done to
Page 53 and 54: 8. Madeline LA and Elster AD. Sutur
Page 55 and 56: Figure 2. Sutural Movement with Spi
Page 57 and 58: Patent Foramen Ovale as a Risk Fact
Page 59 and 60: 90 minutes prior to the start of th
Page 61 and 62: The Relevance of Patent Foramen Ova
Page 63 and 64: In a human population, Glen et al (
Page 65 and 66: Studies evaluating PFO detection me
Page 67 and 68: References 1. O’Rahilly, R., Mull
Page 69 and 70: 55. Giroud, M., Tatou, E., Steinmet
Page 71 and 72: Introduction Altitude DCS Susceptib
Page 73 and 74: Cumulative DCS Incidence, % 100 90
Page 75 and 76: Pharmacological Correction of the H
Page 77 and 78: metabolic regulation remedies [A.S.
Page 79 and 80: asis of these indicators there were
Page 81 and 82: liquidation of energetic debt in mu
Page 83 and 84: Analysis of correlation structures
Page 85 and 86: Interesting data on bemithylum pres
Page 87 and 88: to high altitude hypoxia and allows
Page 89 and 90: 35. Shanazarov, A.S., Ryskulova, G.
Page 91 and 92: Prognozing of the Resistance to Hyp
Page 93 and 94: autonomic cardiac control whereas i
Page 95 and 96: METHOD Subjects 21 male military pi
Page 97 and 98: mean R-R interval (X), STV, LTV (ms
Page 99 and 100:
• Significant negative correlatio
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DISCUSSION Hypoxic Tolerance Our re
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8. Casa M., Casa H., Pages T., Rama
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66. Sheffield P., Heimbach R. Respi
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Abstract Alternobaric Vertigo: Inci
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12. Nagai H. et al. Effect of incre
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Neuropsychometric Test in Royal Net
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Table 4 Results of neuropsychometri
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Summary: Spanish Navy Up to Date Da
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Hypobaric Training for Royal Air Fo
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c. Fast jet high level. Climb to 18
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Introduction Hypobaric Training Iss
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To be able to tolerate breathing pr
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during the change in ambient pressu
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Designing Efficient and Effective,
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The Type II profile involves positi
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Pressurized, Cabin below 10,000 ft
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than 10 minutes at a hypoxia level
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Military Personnel Selection and Di
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expressed by them, are closely inte
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of shortage of blood circulation fu
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The results of the conducted resear
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15-9
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15-11
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In norm there is A > B, and the reg
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Burger, M., 1921, Uber der klinisch
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In: Sbornik nauchno-prakticheskih r
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Templeton, A.W., 1965, Renal Aortog
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Some Psycho-Physiological and Cogni
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Testing in hypobaric chamber condit
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supply immediately recovered. Subje
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The Role of PWC in Declaring a Dive
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Out of 1200 ergometric examinations
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Application of Hypo and Hyperbaric
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evaluation of mountain-climber's hy
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Figure 2 % oxyhemoglobin saturation
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The Effects of Normobaric Hypoxia i
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Memory Scanning Task: Cadets with p
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The statistical analysis of the beh
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ACKNOWLEDGMENTS The authors wish to
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Severe Decompression Illness Follow
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In this set of studies, observation
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pulmonary oedema, a diuretic may be
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Decompression Sickness Research: Ne
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Figure 3. Pigs treated with methano
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Abstract Using “Technical Diving
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ecreational diving training agencie
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After the intermediate or “deco
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include paresthesia, headache, dizz
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practice. Some dives were conducted
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Abstract Into the Theater of Operat
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Procedures: The FCT evaluation init
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The matrix of tests conducted, some
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6. Kennedy, T. Concept of Operation
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The Relevance of Hyperbaric Oxygen
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In reperfusion injury, HBO diminish
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HBO has long been known to favorabl
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3-Nitrotyrosine Predicts Healing in
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corresponded respectively to the si
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that in these diabetic subjects, ne
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Summary Role of a Clinical Hyperbar
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Benefits to the Defence Secondary C
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The study has been deferred due to
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ABSTRACT Incidence of Decompression
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Table 1: Number of Diving Incidents
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Introduction Evaluation of Treatmen
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Table 6A (CF TT6A, initial recompre
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INTRODUCTION Modelling and Validati
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moved to the treatment chamber. Fiv
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Figure 3 The predicted gas in bubbl
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Table 5 shows the same information
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CONCLUSIONS Although it would have
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Respiratory Changes and Consequence
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Table 2 Inspired-expired oxygen dif
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Figure 2 Respiratory patterns, expe
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Apnoea is characteristic of herniat
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Effect of Exercise on Bubble Activi
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The KISS is an index derived from i
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DISCUSSION: In all group comparison
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Thermography - A Method for the Eva
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level atmospheric pressure O2 parti
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lower extremities cephalic extremit
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1-st group - flying crews We divide
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ABSTRACT Altitude Decompression Sic
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Table 1. Results of validation Prof
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Summary Altitude Decompression Illn
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17 oxygen demand regulator with a p
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During these altitude exposures a n
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Subject Number Subject Number Subje
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that this discrepancy in the incide
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Extrapolation of the data presented
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MITCHELL SJ & LEE VM. (2000) A surv
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Expression of Neuronal and Inducibl
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Experimental procedures Groups of 1
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immunoreactive Purkinje cells were
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Western blotting Cerebral cortical
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certain proteins as substrates for
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Griffiths, T., Evans, M.C. and Meld
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Simon, R.P., Griffiths, T., Evans,
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RESUME Intérêt du caisson d’alt
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3. TYMPANOMETRIE La tympanométrie
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quelconque douleur. Dans ce cas, il
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Altitude DCS Research in Support of
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Altitude, feet X 1000 30 25 20 15 1
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2. POST-LANDING EXERCISE AND RISK O
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addition to observed or reported DC
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% DCS 100 80 60 40 20 0 25,000 30,0
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Modeling Approach for Oxygen Exchan
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The first equation states that the
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may cause the remaining discrepanci
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0 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 F
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Sa (%) Pa (mmHg) 100 80 60 40 V’E
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Sa (%) Pa (mmHg) V’E (L/min) 100
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Changes of Ventilator Generated Vol
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Emergency descent : Oxylog 2000 : C
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&DELQ $OWLWXGH IHHW Table 6 &DELQ D
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The Effect of Increased Full Covera
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assembly incorporating FCAGTs infla
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Following garment fitting, subjects
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Mean CBV (cm/s) 70 60 50 40 30 20 1
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Alveolar Carbon Dioxide Tension Alv
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Phase 2 All experimental exposures
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Diffusion coefficient for carbon mo
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Mean arterial pressure (mmHg) 140 1
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In previous studies (Ernsting, 1966
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Determination of the Most Effective
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Decompression Sickness, Extravehicu
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As a corollary, what about the alle
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Introduction Optimizing Denitrogena
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Cumulative % DCS 100 90 80 70 60 50
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Benefit of Acclimatization to Moder
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. Following completion of the quest
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Discussion This study demonstrated
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12. White, D.P., K. Gleeson, C.K. P
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Introduction: Physiological and Cli
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The steepness of hypoxia-induced de
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RESUME Évaluation d’équipements
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2.1. Règlement TSO-C99 Le règleme
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autre personne s’assure que, sans
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Il est équipé de l’équipement
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REPORT DOCUMENTATION PAGE 1. Recipi
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NORTH ATLANTIC TREATY ORGANIZATION
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