Aeromedical Forum: July 2015

If someone’s ever buried a hatchet in your head, you know what a migraine headache feels like. At least that’s what patients have told me.

They can be devastating, incapacitating events. Unfortunately they are common. Over 30 million Americans experience at least one episode every year. That is estimated to account for over $13 billion in lost productivity annually. They can begin in either childhood or adulthood although it’s unusual for them to start after age 50.

To make matters worse, certain types of migraines — those with a visual aura — are associated with an increased risk of stroke or heart disease. By “aura” I mean that some folks will experience blurring of vision, spots before their eyes, jagged lightning bolt like flashes of other funny stuff just before the headache begins.

Migraines can occur with or without auras and sometimes with an aura but no headache. They can last anywhere from 4 to 72 hours if untreated. They are usually throbbing located on one side of the head and associated with nausea or vomiting. Bright lights or loud noises can be excruciating. It’s important not to confuse them with the more common tension or musculo-skeletal type headache that we all get, as well as other less common headaches caused by nerve inflammation. In other words check with you doc for an accurate diagnosis don’t just surf the web!

There are some pretty effective treatments for migraines. If they are mild, over-the-counter ibuprophen or naproxen sometimes can help. Most are more severe however and require one of the so-called triptans.

These are a group of medicines that constrict the dilated blood vessels in the brain that are causing the headache. The oldest is sumatriptan or Imitrex. It’s available as a pill, injection or nasal spray. Other similar products include Maxalt, Zomig, Relpax, etc. Whichever one you are given, it has to be taken at the very onset of a migraine to be of greatest help. The longer you wait the less effective the drug is. As you’d expect these drugs have side-effects that preclude you’re flying while taking them. If you are having frequent migraines and have to be doped up with these things a lot, your doctor might try a preventative medication to take every day. If it comes to that, you probably should be seeing a neurologist — a doc that specializes in the more complex therapies for migraines.

Needless to say the FAA is not too keen about having a pilot flying around with a possibly incapacitating medical condition that is frequently treated with incapacitating drugs. Happily, they have recognized that not all migraines are severe and do allow you AME to issue a medical certificate if certain criteria are met:

• First of all the condition has to be stable and well-controlled on whatever medications the airman is taking.

• The headaches should be the common migraines we talked about, not complicated ones where you lose motor function, have mental status changes, or vertigo

• The airman must not have more than one migraine per month.

• Symptoms should be “Mild’ meaning that you weren’t hospitalized for them and didn’t have to go to urgent care for treatment more than two times over the last year.

• If you are on preventative medications, only two types--beta blockers or calcium channel blockers--are acceptable.

• If you had to take a medication to abort the headache, you should ground yourself, 24 hours if you take a triptan, and as long as 96 hours for other drugs. Check with your AME.

If you meet these criteria you can get your medical certificate on the spot. For more severe migraines, you will have to go through the Special Issuance process, sending in your medical records to the FAA and going through whatever evaluation they consider necessary. Even if it comes to that, don’t give up. The large majority of airman can get certified if they stick with the process!

Fly wisely. See you next month!

As always, comments, questions and suggestions are welcome: jdlakin@mnallergyclinic.com.