Headache and Barometric Pressure: a Narrative Review

  • Kushagra MainiEmail author
  • Nathaniel M. Schuster
Uncommon and/or Unusual Headaches and Syndromes (J Ailani, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Uncommon and/or Unusual Headaches and Syndromes


Purpose of Review

Alterations in atmospheric pressure have been long associated with headaches. The purpose of this review article is to investigate the association of barometric pressure with headache, classifying into two broad categories primary headache disorders (barometric pressure triggering migraine or tension-type headache) and secondary headache disorders (barometric pressure triggering high-altitude headache and headache attributed to airplane travel), discussing the pathophysiology and possible treatments.

Recent Findings

Multiple studies have been performed with inconsistent results regarding the directionality of the association between atmospheric pressure changes and triggering of primary headache disorders, chiefly headaches. Atmospheric pressure is also a trigger of two secondary headache disorders, i.e., high-altitude headache and headache attributed to airplane travel. Hypothesized mechanisms include excitation of neurons in trigeminal nucleus, central and peripheral vasoconstriction, barotrauma, and hypoxia. There are no randomized clinical trials regarding effective acute or preventive treatments.


Greater understanding of pathophysiology may enable both acute and preventive treatments for headaches triggered by changes in barometric pressure. Further studies on the subject are needed.


Headache Migraine Barometric pressure Atmospheric pressure High-altitude headaches Airplane headache 


Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Goldstein JN, Camargo CA, Pelletier AJ, Edlow JA. Headache in United States emergency departments: demographics, work-up and frequency of pathological diagnoses. Cephalalgia. 2006;26(6):684–90.PubMedGoogle Scholar
  2. 2.
    Bigal M, Bordini CA, Speciali JG. Headache in an emergency room in Brazil. Sao Paulo Med J. 2000;118(3):58–62.PubMedGoogle Scholar
  3. 3.
    Luda E, Comitangelo R, Sicuro L. The symptom of headache in emergency departments. The experience of a neurology emergency department. Ital J Neurol Sci. 1995;16(5):295–301.PubMedGoogle Scholar
  4. 4.
    Stovner LJ, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193–210.PubMedGoogle Scholar
  5. 5.
    Hu XL, Markson RB, Lipton RB. Disability and economic costs of migraine in the United States. Ann Intern Med. 1999;159:813–81.Google Scholar
  6. 6.
    Stewart WF, Lipton RB, Simon D. Work-related disability: results from the American migraine study. Cephalalgia. 1996;16:231–8.PubMedGoogle Scholar
  7. 7.
    World Health Organization. Headache disorders 2016. detail/headache-disorders. Accessed April 8, 2016
  8. 8.
    Lipton RB, Stewart SW, Simon D. Medical consultation for migraine results from the American Migraine Study. Headache. 1998;38:87–96.PubMedGoogle Scholar
  9. 9.
    Levy D, Strassman AM, Burstein R. A critical view on the role of migraine triggers in the genesis of migraine pain. Headache. 2009;49:953–7.PubMedGoogle Scholar
  10. 10.
    Kelman L. The triggers or precipitation of the acute migraine attack. Cephalalgia. 2007;27:394–402.PubMedGoogle Scholar
  11. 11.
    Von Mackensen S, Hoeppe P, Maarouf A, Tourigny P, Nowak D. Prevalence of weather sensitivity in Germany and Canada. Int J Biometeorol. 2005;49:156–66.Google Scholar
  12. 12.
    Wober C, Holzhammer J, Zeitlhofer J, Wessely P. Wo berBingo l C. Trigger factors of migraine and tension-type headache: experience and knowledge of the patients. J Headache Pain. 2006;7:188–95.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Hoffmann J, Hendra L, Neeb L, Martus P, Reuter U. Weather sensitivity in migraineurs. J Neurol. 2011;258:596–602.PubMedGoogle Scholar
  14. 14.
    Stewart WF, Lipton RB, Simon D. Work-related disability: results from the American migraine study. Cephalalgia. 1996;16:231–8.PubMedGoogle Scholar
  15. 15.
    Stewart WF, Lipton RB, Whyte J, Dowson A, Kolodner K, Liberman JN, et al. An international study to assess reliability of the Migraine Disability Assessment Score (MiDAS). Neurology. 1999;53(5):988–94.PubMedGoogle Scholar
  16. 16.
    Livescience. Atmospheric pressure: definition & facts 2013. Accessed August 29, 2013.
  17. 17.
    Mainardi F, Lisotto C, Maggioni F, Zanchin G. Headache attributed to airplane travel (‘airplane headache’): clinical profile based on a large case series. Cephalalgia. 2012;32(8):592–9.PubMedGoogle Scholar
  18. 18.
    Bui SBD, Petersen T, Norgaard Poulsen J, Gazerani P. Headaches attributed to airplane travel: a Danish survey. J Headache Pain. 2016;17(33):1–5.Google Scholar
  19. 19.
    •• Bui SBD, Gazerani P. Headache attributed to airplane travel: diagnosis, pathophysiology, and treatment—a systematic review. J Headache Pain. 2017;18(84):1–14 A great review article about HAAT with pooled data from prior case reports and abstracts. Google Scholar
  20. 20.
    Bui SBD, Petersen T, Norgaard Poulsen J, Gazerani P. Simulated airplane headache: a proxy towards identification of underlying mechanisms. J Headache Pain. 2017;18(9):1–10.Google Scholar
  21. 21.
    Marmura M, Hernandez P. High-altitude headache. Curr Pain Headache Rep. 2015;19:9.Google Scholar
  22. 22.
    Kelly PT, Seccombe LM, Rogers PG, Peters MJ. Directly measured cabin pressure conditions during Boeing747-400 commercial aircraft flights. Respirology. 2007;12(4):511–5.PubMedGoogle Scholar
  23. 23.
    Wilson MH, Newman S, Imray CH. The cerebral effects of ascent to high altitudes. Lancet Neurol. 2009;8:175–91.PubMedGoogle Scholar
  24. 24.
    Vardy J, Judge K. Acute mountain sickness and ascent rates in trekkers above 2500 m in the Nepali Himalaya. Aviat Space Environ Med. 2006;77:742–4.PubMedGoogle Scholar
  25. 25.
    The International Classification of Headache Disorders. 3rd edn. Cephalalgia. 2013;33(9):629–808.Google Scholar
  26. 26.
    Scharff L, Turk DC, Marcus DA. Triggers of headache episodes and coping responses of headache diagnostic groups. Headache. 1995;35:397–403.PubMedGoogle Scholar
  27. 27.
    Spierings ELH, Ranke AH, Honkoop PC. Precipitating and aggravating factors of migraine versus tension-type headache. Headache. 2001;41:559–64.Google Scholar
  28. 28.
    Turner LC, Molgaard CA, Gardner CH, Rothrock JF, Stang PE. Migraine trigger factors in a non-clinical Mexican-American population in San Diego county: implications for etiology. Cephalalgia. 1995;15:523–30.PubMedGoogle Scholar
  29. 29.
    Kelman L. The triggers or precipitants of the acute migraine attack. Cephalalgia. 2007;27:394–40.PubMedGoogle Scholar
  30. 30.
    Prince PB, Rapoport AM, Sheftell FD, Tepper SJ, Bigal ME. The effect of Weather on Headache. Headache 2004; 44: 596–602Google Scholar
  31. 31.
    Mukamal KJ, Wellenius GA, Suh HH, Mittleman MA. Weather and air pollution as triggers of severe headaches. Neurology. 2009;72:922–92.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Okuma H, Okuma Y, Kitagawa Y. Examination of fluctuations in atmospheric pressure related to migraine. SpringerPlus. 2015;4:790.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Kimoto K, Aiba S, Takashima R, Suzuki K, Takekawa H, Watanabe Y, et al. Influence of barometric pressure in patients with migraine headache. Intern Med. 2011;50:1923–8.PubMedGoogle Scholar
  34. 34.
    Ozeki K, Noda T, Nakamura M, Ojima T. Weather and headache onset: a large-scale study of headache medicine purchases. Int J Biometeorol. 2015;59:447–51.PubMedGoogle Scholar
  35. 35.
    Cioffi I, Farella M, Chiodini P, Ammendola L, Capuozzo R, Klain C, et al. Effect of weather on temporal pain patterns in patients with temporomandibular disorders and migraine. J Oral Rehabil. 2017;44:333–9.PubMedGoogle Scholar
  36. 36.
    Zebenholzer K, Rudel E, Frantal S, Brannath W, Schmidt K, Wöber-Bingöl C, et al. Migraine and weather: a prospective diary-based analysis. Cephalalgia. 2011;31(4):391–400.PubMedGoogle Scholar
  37. 37.
    • Elcik C, Fuhrmann CM, Mercer AE, Davis RE. Relationship between air mass type and emergency department visits for migraine headache across the Triangle region of North Carolina. Int J Biometeorol. 2017;61:2245–54 A large study revealing no association between migraine ED visits and magnitude of barometric pressure changes. PubMedGoogle Scholar
  38. 38.
    Hoffmann J, Schirra T, Lo H, Neeb L, Reuter U, Martus P. The influence of weather on migraine – are migraine attacks predictable? Ann Clin Transl Neur. 2015;2(1):22–8.Google Scholar
  39. 39.
    Villeneuve PJ, Szyszkowicz M, Stieb D, Bourque DA. Weather and emergency room visits for migraine headaches in Ottawa, Canada. Headache. 2006;46:64–72.PubMedGoogle Scholar
  40. 40.
    Cull RE. Barometric pressure and other factors in migraine. Headache. 1981;21:102–4.PubMedGoogle Scholar
  41. 41.
    Osterman PO, Lövstrand KG, Lundberg PO, Lundquist S, Muhr C. Weekly Headache periodicity and the effect of weather changes on Headache. Int J Biometeorol. 1981;25:39–45.PubMedGoogle Scholar
  42. 42.
    Schulman J, Leviton A, Slack W, Porter D, Graham JR. The relationship of headache occurrence to barometric pressure. Int J Biometeorol. 1980;24:263–9.PubMedGoogle Scholar
  43. 43.
    Gomersall JD, Stuart A. Variations in migraine attacks with changes in weather conditions. A Int J Biometeorol. 1973;17:285–99.PubMedGoogle Scholar
  44. 44.
    Serrano-Duenas M. High altitude headache. A prospective study of its clinical characteristics. Cephalalgia. 2005;25:1110–6.PubMedGoogle Scholar
  45. 45.
    Porcelli MJ, Gugelchuk GM. A trek to the top: a review of acute mountain sickness. J Am Osteopath Assoc. 1995;95:718–20.PubMedGoogle Scholar
  46. 46.
    Messlinger K, Funakubo M, Sato J, Mizumura K. Increases in neuronal activity in rat spinal trigeminal nucleus following changes in barometric pressure—relevance for weather-associated headaches? Headache. 2010;50:1449–63.PubMedGoogle Scholar
  47. 47.
    Sato J. Possible mechanism of weather related pain. Jpn J Biometeorol. 2003;40:219–24.Google Scholar
  48. 48.
    Sato J, Morimae H, Seino Y, Kobayashi T, Suzuki N, Mizumura K. Lowering barometric pressure aggravates mechanical allodynia and hyperalgesia in a rat model of neuropathic pain. Neurosci Lett. 1999;30:21–4.Google Scholar
  49. 49.
    Sato J. Weather change and pain: a behavioral animal study of the influences of simulated meteorological changes on chronic pain. Int J Biometeorol. 2003;47:55–61.PubMedGoogle Scholar
  50. 50.
    Imray CH, Barnett NJ, Walsh S, Clarke T, Morgan J, Hale D, et al. Near-infrared spectroscopy in the assessment of cerebral oxygenation at high altitude. Wilderness Environ Med. 1998;9:198–203.PubMedGoogle Scholar
  51. 51.
    Hadolt I, Litscher G. Non-invasive assessment of cerebral oxygenation during high altitude trekking in the Nepal Himalayas (2850–5600 m). Neurol Res. 2003;25:183–8.PubMedGoogle Scholar
  52. 52.
    Severinghaus JW, Chiodi H, Eger EI II, Brandstater B, Hornbein TF. Cerebral blood flow in man at high altitude. Role of cerebrospinal fluid pH in normalization of flow in chronic hypocapnia. Circ Res. 1966;19:274–82.PubMedGoogle Scholar
  53. 53.
    Wolff CB. Cerebral blood flow and oxygen delivery at high altitude. High Alt Med Biol. 2000;1:33–8.PubMedGoogle Scholar
  54. 54.
    Jensen JB, Wright AD, Lassen NA, Harvey TC, Winterborn MH, Raichle ME, et al. Cerebral blood flow in acute mountain sickness. J Appl Physiol. 1990;69:430–3.PubMedGoogle Scholar
  55. 55.
    Kallenberg K, Bailey DM, Christ S, et al. Magnetic resonance imaging evidence of cytotoxic cerebral edema in acute mountain sickness. J Cereb Blood Flow Metab. 2007;27:1064–71.PubMedGoogle Scholar
  56. 56.
    Houston CS. Incidence of acute mountain sickness at intermediate altitudes. JAMA. 1989;261:3551–2.PubMedGoogle Scholar
  57. 57.
    Laury AM, Chen PG, McMains KC. Randomized controlled trial examining the effects of balloon catheter dilation on “sinus pressure” / barometric headaches. Otolaryngol Head Neck Surg. 2018;159(1):178–84.PubMedGoogle Scholar
  58. 58.
    Mainardi F, Lisotto C, Maggioni F, Zanchin G. Headache attributed to airplane travel (‘airplane headache’): clinical profile based on a large case series. Cephalalgia. 2012;32(8):592–9.PubMedGoogle Scholar
  59. 59.
    Olesen J. ICHD-3 Cephalalgia. 2018: 38(1) 1–211Google Scholar
  60. 60.
    Swenson ER. Carbonic anhydrase inhibitors and high altitude illnesses. Subcell Biochem. 2014;75:361–86.PubMedGoogle Scholar
  61. 61.
    Low EV, Avery AJ, Gupta V, et al. Identifying the lowest effective dose of acetazolamide for the prophylaxis of acute mountain sickness: systematic review and meta-analysis. BMJ. 2012;345:e6779.PubMedPubMedCentralGoogle Scholar
  62. 62.
    Hackett PH, Roach RC, Wood RA, et al. Dexamethasone for prevention and treatment of acute mountain sickness. Aviat Space Environ Med. 1988;59:950–4.PubMedGoogle Scholar
  63. 63.
    Johnson TS, Rock PB, Fulco CS, Trad LA, Spark RF, Maher JT. Prevention of acute mountain sickness by dexamethasone. N Engl J Med. 1984;310:683–6.PubMedGoogle Scholar
  64. 64.
    Basnyat B, Gertsch JH, Holck PS, Johnson EW, Luks AM, Donham BP, et al. Acetazolamide 125 mg BD is not significantly different from 375 mg BD in the prevention of acute mountain sickness: the prophylactic acetazolamide dosage comparison for efficacy (PACE) trial. High Alt Med Biol. 2006;7:17–27.PubMedGoogle Scholar
  65. 65.
    Vuyk J, Van Den Bos J, Terhell K, et al. Acetazolamide improves cerebral oxygenation during exercise at high altitude. High Alt Med Biol. 2006;7:290–301.PubMedGoogle Scholar
  66. 66.
    Basu M, Sawhney RC, Kumar S, Pal K, Prasad R, Selvamurthy W. Glucocorticoids as prophylaxis against acute mountain sickness. Clin Endocrinol. 2002;57:761–7.Google Scholar
  67. 67.
    Practical Pain Management. Migraine with aura more common at higher altitude. https://www. Accessed June 9 – 12, 2016
  68. 68.
    Mainardi F, Maggioni F, Lisotto C, Zanchin G. Diagnosis and management of headache attributed to airplane travel. Curr Neurol Neurosci Rep. 2013;13(335):1–6.Google Scholar
  69. 69.
    Berilgen MS, Mungen B. A new type of headache, headache associated with airplane travel: preliminary diagnostic criteria and possible mechanisms of aetiopathogenesis. Cephalalgia. 2011;31(12):1266–73.PubMedGoogle Scholar
  70. 70.
    Ipekdal HI, Karadas O, Oz O, Ulas UH. Can triptans safely be used for airplane headache? Neurol Sci. 2011;32:1165–9.PubMedGoogle Scholar
  71. 71.
    • Nierenburg H, Jackfert K. Headache Attributed to airplane travel: a review of literature current pain and headache reports. 2018;22:48 A very good review article about recent advancements in HAAT. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurologyAugusta UniversityAugustaUSA
  2. 2.Department of AnesthesiologyUCSD School of MedicineLa JollaUSA

Personalised recommendations