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Q: Flying after concussion ( Answered 5 out of 5 stars,   0 Comments )
Subject: Flying after concussion
Category: Health > Conditions and Diseases
Asked by: selectosa-ga
List Price: $10.00
Posted: 22 Sep 2005 02:05 PDT
Expires: 22 Oct 2005 02:05 PDT
Question ID: 570822
I have recently suffered a minor concussion during a traffic
accidents. I have a flight scheduled 5 days after my concussion. My
parents, as formber surgeons, are claiming that flying after
concussion is bad for you. Is this true and why (or why not).
Subject: Re: Flying after concussion
Answered By: crabcakes-ga on 22 Sep 2005 11:53 PDT
Rated:5 out of 5 stars
Hello Selectosa,

   It appears you have asked a virtually unanswerable question!

  ?Question: I am a brain injury survivor who occasionally travels by
plane and noticed that traveling this way increases my head pain. I
don?t know the cause of this extra discomfort, but I wonder if my head
is affected by the air pressure within the plane?s cabin? If [your
organization] has published articles in the past about this topic,
would you please send me a copy. If you haven?t any previously
published information, would you consider it for a future article? I
would like to know what is happening when I fly and if anything can be
done to prevent this from happening.

?Answer: You bring up an interesting point that has not been written
about, to the best of my knowledge, in the context of post traumatic
headache pain. In the context of someone with post traumatic headache,
an individual with "decreased physiologic stress tolerance" may find
any physiologic stress, including high altitudes, particularly in
sub-optimally pressurized planes, physiologically taxing. It may come
as a surprise to readers, but commercial planes typically are only
pressurized to an equivalent of 6,000 to 8,000 feet. I have also seen
patients with post-traumatic epilepsy who have developed headaches
that were epilepsy related and/or actual seizures when flying at high
altitude, particularly in what may have been sub-optimally pressurized

There is very little specific information on this topic and it
certainly warrants further research. Thanks for your inquiry.?
Nathan D. Zasler, MD, FAAPM&R, FAADEP, CIME
Medical Director, Concussion Care Center of Virginia 
CEO & Medical Director, Tree of Life

The Merck Manual, ?Problems in Transit? page lists various health
problems and flying, but concussion is not listed.

I see nothing contraindicating travel by plane in people who have had
concussions to fly in this article from American Family Physician:

?Commercial jet aircraft maintain a relative cabin altitude between
5,000 and 8,000 feet during routine flight, with the FARs specifying
that an 8,000-foot environment be maintained even at the highest
operating altitude. At this relative altitude, the barometric pressure
(Pb) decreases from a normal sea level value of 760 mm Hg to around
560 mm Hg, causing the normal baseline arterial partial pressure of
oxygen (Pao2) of 98 mm Hg at sea level to decrease to around 60 to 70
mm Hg in normal individuals.6 This corresponds to approximately a 90
percent oxygen saturation (Sao2) on the oxyhemoglobin dissociation
curve, a point below which there is a steep gradient of the
pressure/saturation relationship. Using 50 to 55 mm Hg as a minimum
acceptable Pao2 level for a healthy person,7 passengers with
cardiovascular, circulatory or pulmonary compromise associated with a
reduced Pao2 before flight could easily experience symptoms related to
hypoxemia at normal cabin altitudes. An arterial blood gas
determination is therefore recommended before travel for passengers
with any symptomatic lung disorders.?

?Increasingly, patients are traveling specifically to have an
outpatient procedure performed with the intent of traveling home as
soon as possible. It should be remembered that although airlines are
obligated by the Air Carrier Access Act1 to allow boarding of
passengers unless there is a chance that extraordinary medical
assistance in-flight may be required, travel should be delayed as long
as possible to decrease the chance of complications.?

?I had suffered a double brain concussion, and my brain swelled so
badly the doctors thought they would have to drill holes in my skull
to relieve the blood pressure. Fortunately, they didn't have to do
that because the swelling went down.?
?The things listed on my profile that I couldn't do made me feel like
there was little that I could do! No driving for a year, no climbing
on top of aircraft, no going inside an aircraft unless the ramp was
down and I could walk up it. I couldn't stand for more than 10
minutes, walk more than a mile, run, do physical training, and - for
the fear of black-outs - go anywhere alone. My flying and crewing days
were over for the next couple of years.?

?Typically, commercial airplanes fly at an altitude of about 38,000
feet. The cabin is pressurized to make it safe and comfortable at that
extreme altitude ? but this does not make breathing in an airplane the
same as breathing on the ground. Most people are not surprised that
the humidity and air pressure of airplane air decreases as the plane
ascends. But that?s not all that changes. At sea level, the air we
breathe contains about 21 percent oxygen; on a typical commercial
flight, the cabin air has only about 15 percent oxygen.? ?Anyone who
has been hospitalized within the last 6 weeks with respiratory
problems should not fly without a pre-flight evaluation. For children
with specific conditions such as cystic fibrosis, sickle cell anemia,
or Down syndrome, it?s important to at least talk with your doctor
about the risks of flying.?
This is about children, but the same applies to adults.

This site does not contain the answer to your question, but is full of
information for people who have had concussions:

Your best bet is to visit your doctor, who will know what concussion
grade you suffered, as well as your medical history. S/he is the right
person to advise you on the safety of flying. Perhaps the following
advice, to athletes who have suffered a concussion says it best:
?After a concussion, always get your doctor's OK before returning to a
sport. Wait until all of your neurological symptoms have completely
gone away.?

If any part of this answer is unclear, please request an Answer
Clarification, before rating. I will be happy to assist you further,
on this question.

Sincerely, Crabcakes

Search Terms

Cabin pressure + brain injury
flying + plane + after brain injury + pressurized cabin
flight + post concussion
altitude + brain injury
selectosa-ga rated this answer:5 out of 5 stars

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