It’s happened to most of us at one time or another: You tighten your goggles another notch to stop water from trickling in, then pressure above your eye that started as an irritation quickly advances to head pain.
Alan Diamond, a neurologist and Masters swimmer in Fayetteville, Ark., shares insights on this common swimmer’s malady.
“External compression headache (ECH) occurs from headwear putting continuous pressure on the cutaneous nerves of your forehead and scalp. ECH is an under-recognized syndrome as most do not seek medical attention,” Diamond says. “ECH is most commonly experienced by athletes who use helmets, tight-fitting hats, headbands, swim caps, or swim goggles, and is associated with a constant, nonpulsatile [nonpulsating] pain. It’s more severe at the site of pressure. The pain can increase over several minutes and resolves after the pressure is removed. There are no associated symptoms—nausea, light and sound sensitivity, worsening with exertion,” he says.
There’s a physiological reason tight headwear induces pain—compression of any one or more of the various nerves in the head. The four nerves Diamond says are typically involved in ECH include the supraorbital nerve, which lies above the eye socket and below the forehead; the supratrochlear nerve, a branch of the frontal nerve that runs near the brow ridge; the auriculotemporal, a branch of the mandibular nerve that line the side of the face; or the zygomaticotemporal nerves beneath each eye.
How nerves react to the pressure put upon them by headwear can vary widely from swimmer to swimmer. Some swimmers can tighten their goggles to extremes while others have to be very cautious or suffer painful consequences. This variance is, in part, due to differences in skull anatomy. Some people have a tiny foramen, or opening, in their skull at the inner edge of the eye socket above the eye, while others have a notch in this area that can leave the nerve beneath it more exposed. “Swimmers with a supraorbital notch rather than supraorbital foramen have a greater risk for ECH due to compression of the exposed nerve,” Diamond says.
Similarly, other conditions can contribute to these kinds of headaches. “Athletes with a history of migraines are believed to be at risk for ECH,” Diamond says.
As a frequent migraine sufferer myself, I find that racing goggles fitting under the brow hurt me the most, while goggles sitting on or slightly above the brow or on the forehead (like a diving mask) are usually very comfortable. Diamond explains the science behind my observations:
“The regular [under the brow goggle] would be more likely to compress the supraorbital nerve. I suspect this would be worse with a notch rather than foramen. The mask goggles tend to fit a little higher than the notch/foramen and are more padded.”
What’s more, Diamond says that for those who suffer from migraines, ECH can be a trigger “in some people if the headwear is worn too long.”
In competition, I wear the goggles tight enough to create some head pain, but the race duration is short enough that the pain doesn’t escalate to a migraine if I revert to a looser pair for my cool down.
Trying different types of goggles and positions can help you find the fit that works best for you. “It may be helpful to place goggles in different positions to avoid repeated pressure, wear goggles made of softer rubber, or a looser-fitting strap around the head,” Diamond says.
Though annoying, for most of us, ECH is not a major medical concern, Diamond says. “Most [swimmers] with ECH do not need to see a doctor as it [typically] resolves within one hour after removal of the offending headwear.” However, he cautions, “seek medical attention if your headache continues or changes.”
About the Author
Susan Dawson-Cook
Susan Dawson-Cook has acquired 47 Top 10s since joining Masters Swimming in 2008. She is also an avid open water swimming enthusiast, especially anytime dolphins are around. She has been a fitness trainer and instructor for more than 30 years and is a RYT 200 Yoga Alliance certified instructor. She is the author of "Swimming With Dolphins," "Fitter Than Ever at 40 and Beyond," "Fitter Than Ever at 50 and Beyond," and "Slim for Life Secrets." Susan teaches yoga online and offers yoga retreats in Tucson, Arizona, and San Carlos, Mexico.
