Imagine this: You’re about to jet off to the summer vacation of your dreams, and hopefully get some much-needed R&R. You get through the airport and finally settle into your seat on the plane. But after an hour or so, bam, a migraine strikes. That all-too-familiar throbbing headache pain spreads, you get woozy, and just feel overall…bleh. It may seem random, but flying (and travel in general) can make migraine attacks more likely to happen.

It’s true—while everyone has different migraine triggers, being on a plane is a pretty common one for people who live with migraines. Before the airplane-related head pain begins, some (though not all) may go through the aura phase of a migraine and notice vision changes like the following, per Mount Sinai:

• Temporary blind spots or colored spots
• Blurred vision
• Eye pain
• Seeing stars, zigzag lines, or flashing lights
• Tunnel vision (only able to see objects close to the center of the field of view)

Once the headache hits (which can be throbbing, pounding, or pulsating), you may also have nausea, vomiting, and extreme sensitivity to light, sound, and smells.

We know: A flight-induced migraine sounds miserable. Fortunately, there are ways to prevent (and manage) migraines when you’re onboard, to keep you from totally giving up on your vacay plans.

We spoke with Anna Pace, MD, assistant professor of neurology at the Icahn School of Medicine at Mount Sinai and director of the Headache Medicine Fellowship Program, about why air travel can trigger migraines and what to do pre-, during, and post-flight to avert an attack.

What causes a migraine when flying?

Unfortunately, flying is a perfect storm of migraine triggers. Here are just a few of the most common:

1. Cabin pressure

Do your ears pop when you’re on a plane? This is from changes in air pressure during takeoff and landing. “The change in air pressure (or barometric pressure) that comes with flying” is also one of the most common migraine triggers, says Dr. Pace.

This shift in pressure upsets the balance of fluid in your sinuses, causing head pain, per the Cleveland Clinic. There’s also a theory that barometric changes may affect pressure on your brain, altering how it senses pain, but more research is needed to confirm this.

Because pressure changes are strongest in takeoff and landing, migraines attacks are more likely to strike at these times, per the Migraine Foundation Aotearoa New Zealand.

“The change in air pressure that comes with flying” is also one of the most common migraine triggers.—Anna Pace, MD

2. Motion

For some people, turbulence turns their stomach. And people with migraine are more susceptible to motion sickness, according to an August 2010 paper in Progress in Neurobiology¹. Motion sickness usually comes with a side of nausea, dizziness, and headache, so it makes sense that it can induce a migraine attack.

3. Light

Those ultra-bright artificial lights on planes can aggravate migraines, too. In fact, extreme light sensitivity, a condition called photophobia, is one of the criteria used to diagnose migraines, according to the American Migraine Foundation.

4. Lack of sleep

Whether you can’t sleep on planes (a lot of people just can’t get comfortable), or your flight is at 6 a.m. (and you only caught a few winks the night before), traveling can mess up your sleep schedule. And erratic sleep can induce a migraine.

5. Dehydration

Between the dry air on the plane and the complimentary salty peanuts, you might find yourself dehydrated when you fly. Dehydration can make you dizzy and lightheaded, so it’s no surprise that it’s a trigger for a third of migraine sufferers, according to the American Migraine Foundation.

6. Dry air

The humidity in airplane cabins is very low, which can dehydrate you, according to The Migraine Trust. And as we’ve learned, dehydration and migraine don’t mix well.

7. A change in eating and drinking habits

On the day of travel, “people may skip meals due to the timing of their flights or may eat more processed, quick-and-easy foods that may trigger migraine attacks for some,” Dr. Pace says.

8. Stress

While going on vacation should be relaxing, some aspects—like flying—can also be a bit stressful. “Some people may find flying stressful or anxiety-inducing (especially if running late, trying to find your gate, or worrying about checking your luggage), which can also make people more vulnerable to migraine attacks,” Dr. Pace says.

Actually, stress is a trigger for most people (about 70 percent) with migraine, according to the American Migraine Foundation.

How is this different from an airplane headache?

Even if you don’t get migraines, flying can still cause head pain for some people. Known as an “airplane headache,” it involves a severe pain on one side of the forehead and eye area, according to the Migraine Foundation Aotearoa New Zealand. Once again, a change in cabin pressure seems to be the culprit.

While airplane headaches and migraines both produce head pain, there are some key differences. These include the following, per Dr. Pace:

• An airplane headache only happens during airplane travel (generally during ascent and/or descent). On the other hand, migraines can happen at any time during the travel process. (You can even get a migraine after flying.)
• Airplane headaches are typically shorter than most migraine attacks. They usually subside within 30 minutes whereas migraines can last much longer (between four and 72 hours if untreated).

So what can you do if an airplane headache strikes? “Since this is a rare headache type, and they typically resolve after the takeoff or landing of the plane, there aren’t a lot of studies on treatments, but most of my patients use usual over-the-counter (OTC) medications like anti-inflammatories or a triptan [a type of prescription medicine used to treat migraine] if they have one on hand,” Dr. Pace says.

But you may not even need to pop a pill. “Sometimes the [airplane] headache resolves before the person can grab a medication and take it,” she says.

How to prevent a migraine when flying

While you can’t always avoid a migraine attack during air travel, you can lower your risk, so you can enjoy your plans once you land. Try these tips to help you stay pain-free each step of the way.

Pre-flight

• Plan ahead when scheduling a flight. “Try to avoid red-eye flights if possible, or flights that may disrupt your sleep schedule (i.e., that cheap 5 or 6 a.m. flight, especially if it means you need to get up much earlier than usual to get to the airport and you miss breakfast),” Dr. Pace says.
• Pack your migraine meds in your carry-on. “It’s important to make sure your carry-on has all of your acute medications or treatments in the case you may need them,” Dr. Pace says. You can also pack anti-nausea medication like Dramamine, or OTC pain relievers like Excedrin.
• Eat before you get to the airport. Missing a meal can trigger a migraine, so keep your belly full and happy. It’s also a smart idea to bring healthy, well-balanced snacks on the plane (think: a protein bar, raw nuts and dried fruit, etc.), Dr. Pace says.
• Take a reusable water bottle. “So you can stay well-hydrated after you go through security and while on the flight,” Dr. Pace says. Just remember to empty it out before going through airport security. You can refill it once you get to your gate.
• Bring your own eye mask, ear plugs, or pillow. This can help reduce any outside factors (like bright lights, noise, etc.) that can exacerbate an attack, Dr. Pace says. An airplane neck pillow is a good choice.
• Meditate before you board. “If travel is stress-inducing, it can be helpful to do some mindfulness or deep breathing exercises pre-flight, or download a few podcasts on meditation or mindfulness to listen to while waiting at your gate,” Dr. Pace says.
• Leave plenty of time to arrive at the airport and go through security. “Some people find the time crunch/rushing to be stressful, so you’d want to minimize any risk of that affecting the likelihood of a migraine,” Dr. Pace says.

During flight

• Snack frequently. “Think healthy options rich in magnesium, B2, and omega-3s, or snacks with protein and healthy fats or whole grains,” Dr. Pace says. Some great options are trail mix, crackers and hummus, or a granola bar. Just try to avoid any foods that tend to trigger migraines for you—like dairy and cured meats, for example.
• Stay well-hydrated. Remember, dehydration is a common migraine trigger, so sip on H2O throughout the flight. (You can choose an aisle seat in advance if you think you’ll get up to pee a lot.)
• Avoid or limit alcohol and caffeine. Both are known to trigger a migraine attack, Dr. Pace says.
• Stretch often. “It can also be helpful to do gentle neck and arm/shoulder stretches and get up from your seat to walk and move around where possible (only when the pilot says it is safe to do so!),” Dr. Pace says.

Post-flight

• Get some sleep. You might be tempted to down a cup of joe and hit the ground running, but catching up on your zzzs (especially if there’s a time zone difference) is the best way to prevent a migraine attack, Dr. Pace says.
• Take it easy. Don’t pack your itinerary with too many activities upon your arrival. “Many people avoid scheduling important meetings or outings for some time after landing so they can regroup,” Dr. Pace says. “I think this is a really great idea, especially for people with migraine who tend to get attacks during air travel.”
• Get into a routine. Even if you’re only traveling for a short time, establishing a routine “with meals and hydration once you are at your destination can help,” Dr. Pace says.

How to treat a migraine if you’re already on the plane

Even if you’ve done everything you can to prepare, a migraine attack can still strike mid-flight. Here’s how to cope if it does:

1. Take your meds

“If you’re already on the plane and you have a migraine attack, it’s best to treat it with your acute medications on hand, whether that is a triptan, a gepant [a medicine used to treat migraines], an NSAID, an anti-nausea med, or something of that kind (or combo!),” Dr. Pace says. If you’re unsure of the best combo of meds to take, ask your doctor in advance.

The sooner you take your medication, the better. “Try to treat as early as you can to maximize the likelihood of relief,” she says. That means, pop your pill at the first sign of a migraine attack—whether that’s blurred vision, nausea, or pain.

2. Ask for an ice pack

Also, “consider asking a flight attendant for ice packs, if you know that is something that can typically help alleviate some pain,” Dr. Pace says. If they don’t have actual ice packs, they can put a few cubes into a plastic bag for you. The cold decreases blood flow to the brain, which can provide pain relief.

3. Cover your eyes

Wear your eye mask (or ask a flight attendant for one if you forgot to pack your own). This can block out the bright, harsh lights on the plane that may aggravate your head pain. Once your eyes are covered, try to get some shut-eye to sleep off the pain.

4. Settle your stomach

“If you feel queasy or nauseated, try to eat saltines or have ginger ale to settle your stomach a bit,” Dr. Pace says. This could also be where the Dramamine comes into play.

5. Stay hydrated

Once again, little sips of water can go a long way. If you have trouble remembering to drink on the flight, set alarms or reminders on your phone to go off periodically. You’ll know you’re properly hydrated if take a bathroom break and your pee is light yellow/clear, per UCI Health.

The bottom line

For people who get migraines, flying is a common trigger. Luckily, there are things you can do to prepare to help prevent, or at least reduce your risk, of a migraine. Avoiding, managing, or minimizing known triggers—like dehydration, stress, and lack of sleep—is half the battle.

Still, migraine attacks aren’t always avoidable. “Sometimes you do everything right: you plan ahead, you bring all of your meds and snacks, you hydrate super well on the flight, and you still get a migraine,” Dr. Pace says. “Give yourself grace, and know it is not your fault. Migraine can be unpredictable.” In other words, it’s totally okay to hang in your hotel room for the first day (or couple hours) of vacation ’til you feel better.

“If you’re consistently getting migraine attacks with airplane travel, and your usual remedies are not helping, consider seeing a neurologist or headache specialist for more guidance and treatment options,” Dr. Pace says.

—reviewed by Smita Holden, MD