THE CLINICAL SYNDROME

• The rise in incidence of a condition known as "swimmer's headache" can be attributed to the rising number of individuals who are participating in swimming as part of a well-rounded program of physical training.

  • This painful ailment is more accurately classified as a compressive mononeuropathy, despite the fact that an individual suffering from swimmer's headache most commonly complains of a unilateral frontal headache that arises shortly after he or she begins to swim.

• If a swimmer wears goggles that are either too large or too tight, they will get swimmer's headache.

  • This is because the supraorbital nerve is compressed as it exits the supraorbital foramen.

SIGNS AND SYMPTOMS

• Typically affecting only one side of the head, swimmer's headache affects the skin and scalp that are supplied by the supraorbital nerve.

• In most cases, the symptoms of swimmer's headache appear as cutaneous sensation above the damaged supraorbital nerve, which then extends into the ipsilateral forehead and scalp.

  • This sensitivity can eventually lead to uncomfortable dysesthesias and allodynia, and the patient will frequently remark that his or her hair is painful.

  • When the supraorbital nerve is compressed over an extended period of time, the area around the supraorbital region and the forehead may begin to feel "woody" or anesthetized.

• An allodynia or, in extremely rare cases, anesthesia may be detected during a physical examination in the region where the compressed supraorbital nerve is located.

  • Because of the tight goggles, certain patients may occasionally present with edema of the eyelid.

  • This condition is caused by compression of the soft tissues in the eyelid.

  • In extremely rare cases, purpura may be present as a result of damage to the delicate blood vessels that are present in the loose areolar tissue of the eyelid.

TESTING

• There is currently no diagnostic procedure available for swimmer's headache.

  • The primary goal of the testing is to uncover a hidden pathologic process or another disease that may present symptoms similar to those of swimmer's headache.

• All patients with a recent onset of headache that is suspected to be swimmer's headache should have a magnetic resonance imaging (MRI) of the brain performed.

  • Additionally, strong consideration should be given to obtaining a computed tomography (CT) scanning of the sinuses, with special attention being paid to the frontal sinuses due to the prevalence of sinusitis in swimmers.

• If the diagnosis of swimmer's headache is uncertain, screening laboratory tests, which include a complete blood count, an erythrocyte sedimentation rate, and automated blood chemistry, should be conducted.

DIFFERENTIAL DIAGNOSIS

• The clinical criteria for diagnosing swimmer's headache often consist of acquiring a specific headache history from the patient.

  • Even though there are significant variations between the two types of headaches, swimmer's headache is sometimes misinterpreted as migraine headache.

  • A mistake like this can lead to treatment strategies that don't make much sense and poor symptom management for headache sufferers. identifies swimmer's headache as a distinct condition from migraine headache and should help the practitioner arrive at the correct diagnosis.

• MRI and CT scans can help differentiate between disorders of the frontal sinuses, which can cause symptoms similar to those of swimmer's headache.

• Temporal arteritis can occasionally be mistaken for swimmer's headache, despite the fact that patients with temporal arteritis appear to be sick throughout their bodies.

• The term "swimmer's headache" has also been known to be used to erroneously diagnose intracranial diseases like tumors.

TREATMENT

• Taking off the goggles that are causing the problem is the first and most important step in treating swimmer's headache.

• When the patient is advised to put their goggles on, they should be cautioned to avoid placing them directly over the supraorbital nerve. This warning should be communicated to the patient verbally.

• Custom-fitted goggles with a smaller area of seal around the eyes that do not compress the supraorbital nerve but are large enough to avoid compressing the globe may be required on rare occasions.

• In most cases, simply switching to a new pair of goggles made of softer rubber is enough to solve the problem. However, on rare occasions, this solution is not sufficient.

• Symptomatic relief can be achieved with the use of analgesics or nonsteroidal anti-inflammatory medications. Abuse of any substance, including legal ones like these, can however have devastating effects on a person's life.

COMPLICATIONS AND PITFALLS

• The majority of the time, swimmer's headache is a painful ailment that goes away on its own and is simple to treat once the cause has been identified.

• If the problematic eyewear are not removed as soon as possible, there is a possibility that irreversible nerve injury, along with the associated dysesthesias and numbness, will occur.

  • The consequences of failing to diagnose a coexisting intracranial disease or systemic disease, such as frontal sinusitis or a tumor, might be catastrophic.