Banks Anderson

Migraine‐like phenomena after decompression from hyperbaric environment

THE VASCULAR mechanisms underlying the clinical symptomatology of migraine headaches are not completely understood. The classical picture of visual scintillations followed by a localized throbbing headache is thought to be caused by constriction of the posterior cerebral vessels with subsequent vasodilation of painsensitive intracranial or extracranial arteries. Migraine-like syndromes, however, have also been associated with other conditions such as vascular malformations’s2 and arteriographic procedures,3s4 suggesting that the vasomotor reactivity underlying the phenomena may be provoked by nonspecific mechanisms. The clinical characteristics of migraine have also been observed in decompression sickness in normal subjects.5.0 In such patients, the headache often appeared after descent from simulated altitudes of 30,000 to 38,000 ft. in a low-pressure chamber. The present report describes similar migraine-like illnesses after ascent from simulated depths of 66 to 135 ft. below sea level in a hyperbaric chamber. Scintillating scotomas and headaches, sometimes associated with paresthesia of the hand and focal electroencephalographic abnormalities, appeared in 4 young professional workers (1 nurse and 3 physicians), 3 of whom had a past history of vascular headaches of the migraine type. The clinical features of their disorder suggested attacks of migraine, hut their illnesses may have represented minor forms of decompression sickness. It is the purpose of this report to call attention to this phenomenon, which can be expected to appear more frequently in view of the greater use of hyperbaric chambers for medical purposes and the increasing extent of deep submergence activities.

Activity and Diabetic Vitreous Hemorrhages

To ascertain the relationship between activity and vitreous hemorrhage, we questioned 72 consecutive diabetic patients presenting with 95 episodes of vitreous hemorrhage. The activity most commonly associated with symptoms of hemorrhage was sleep (36%) followed closely by sitting or lying (26%). Only one of six hemorrhages was associated with activity that could be considered more strenous than walking. Limiting the activity of diabetic patients does not seem an effective method of preventing vitreous hemorrhage.