I also had an eardrum rupture in flight -- and yes, it feels like entire head wil explode. Thankfully, in "F", FA's kindly brought bottled water, but nothing stopped the pain until the darn thing burst.

I'd flown outbound following all MD instructions for use of decongestants, nasal sprays. Doc recommended Afrin for me as well -- OK if very temporary, and it worked the very first time I used it on outbound flight. THought I was fine for return three days later, with same strategy, but Afrin failed (didn't ever work quite as effectively as first-ever dose), and eardrum ruptured on ascent from DTW-LGA. After stopver in NYC and call to my MD, I canceled last flight segment and opted to take Amtrak home. Have not had hearing tested since, but worry about lasting damage.