Abstract text (incl. figure legends and references)

BACKGROUND: According to ICHD-3 Headache Attributed to Airplane Travel is described as a severe headache, usually unilateral and periocular and without autonomic symptoms, occurring during and caused by aeroplane travel. A recent study reveals some differences in the clinical presentation and suggests a need for refining the criteria. AIM: To describe a case of headache attributed to airplane travel, accompanied by autonomic symptoms and longer duration. CASE PRESENTATION: A 34y woman with severe headache, which developed first on an aeroplane travel during landing and repeats ever since during landing. Pain is of shock-like nature, VAS=10, localized periocularly on the left, accompanied by nausea, vomiting, tearing of the right eye, followed by subsequent tearing of the left one. A discharge of clear secretion from the right nostrail is also present. Headache improves after landing but does not subside. It might contunue 1-3 days with a milder intensity. It is so unpleasant, the patient does not want to travel by plane. Apart from that, a classical clinical characteristics of migraine with visual aura (black dots in the vision field) is reported again on the left side with photo-, phonophobia, and nausea, no other autonomic symptoms, restlessness or aggitation. Patient had concurrent bronchial asthma. Neurological exam-normal. MRI showed small tempo-parietal lesions of a vascular nature; without any sinus pathology. The case most likely refers to both: 1) headache associated with airplane travel and 2) migraine with visual aura. However, the presence of autonomic symptoms is not alligned with the ICHD-3 definition for airplane headache. Additionally, the headache does not remit after landing wich is another discrepancy. The migraine with aura is co-existing. CONCLUSION: Based on the described clinical characteristics, it seems that headache attributed to airplane travel might present also with accompanying autonomic symptoms like lacrimation and rhinorhea.