migraine

[waveydavey]

I used to suffer from exertion induced migraine - this occurred when I seriously pushed myself physically ie a fast run over 10 miles.

I dont get them anymore (I also don't try to run fast over 10 miles anymore since common sense kicked in).

Point is, can the fact I have suffered from these in the past prevent me from passing a class 1? I have never suffered a migraine for a few years now but I feel I have to mention it to the doc.

[Loose rivets]

I'm a pilot, not a doctor, but a huge amount has been written about migraine in the past. I haven't seen much in the last year or so. If you can't search for it under classical migraine, or my screen name, let us know and I'll see if some of the notes are still on my laptop.

Also confirm if you have had a proper diagnosis, and that you are suffering from visual disturbances.

[waveydavey]

I couldn't find anything on here reagrding previous discussions on migraine... I have had it diagnosed as a classical migraine - visual disturbance followed by headache. However like I stated I have not suffered from one for a good while now, probably around 2 or 3 years. I'm concerned it still may prevent a class 1 being obtained.

[Hawk]

Hello waveydavey. Just a quick search through the Forum's archives. Ninty-six posts, not all exactly relevant of course, but hopefully useful.
http://www.pprune.org/forums/search.php?searchid=435129
cheers
Medical Moderators.

[waveydavey]

Thanks for your help. I found this article by one of the CAA consultants that others may find useful - particularly the flowchart on the last page re fitness for class 1 for previous migraine sufferers.
http://pn.bmjjournals.com/cgi/reprint/4/6/322.pdf

[Loose rivets]

It's an interesting document and frankly I'm surprised that they have such a logical process of determining fitness. Unfortunately migraine does not usually follow a precise pattern, but yours does sound as though it had a very clearly defined trigger.

I'm particularly interested in your assessment that the migraine was caused by an activity that caused your heart to be really pushed to the limits. As someone that was keen on judo to an unseemly age, I know the difference between jogging and running.

About three years ago there was some excitement in the findings that a small leak in the heart would cause a migraine-triggering hormone to be produced. This [small hole] was a congenital disorder, and almost always found by chance as the patient had no symptoms...except that there was a high incidence rate of migraine noticed. This was a good bit of deduction on the part of the researchers. I would be very interested to know, if and when you have a detailed heart check-up, if such a leak is found. However, just the extreme pushing to limits may have caused the release of such a hormone.

The gist of my posts over the years has been that the brains blood vessels are caused to restrict flow because of some perceived threat, more often than not, following long underlying worry. This is a totally counter-productive reaction, and was for a long time deemed to be the direct cause of the symptoms.

However, it is my belief, that the problems start when a hormone is produced, as a matter of urgency, to dilate these clamped blood vessels. Only minute amounts of this complex substance would need to cross the blood/brain barrier, to profoundly affect localized areas of brain function.

[waveydavey]

Loose rivets, I too was aware of the theory regarding the small hole in the heart and I had read that this possibly was linked to increase risk of minor strokes. This seems to have a greater impact on divers according to limited research and may lead to greater chances of developing a bend while on deeper dives.
I dive regularly and due to this I thought I would mention it to my doctor recently, as well as the fact that although I have not had one of these migraines for several years now I want to know if the stroke risk is there(At this time I was not aware it could affect my class 1). I also showed him some supporting research, I expected him to tell me not to worry but instead he referred me to a specialist in order to give me peace of mind. This involved a discussion with the specialist, then an ultrasound scan of my heart. I havent had the formal results (I have another appointment soon) but the person doing the scan said they could find no sign of a hole. This however may not mean anything as in my case it only becomes apparent during extreme excertion and therefore it may require a large increase in blood pressure to start the process.
Alternatively it may now have healed explaining why I have not had a reoccurrance for some time.
I now need to ask the specialist to write a report for the caa in order for them to consider my fitness for a class 1.
For your info these are the articles I presented to my doc, who was not familiar with the research at that time.
http://www.sciencenews.org/articles/20050219/bob8.asp
http://www.clinsci.org/cs/100/0215/1000215.pdf

[Loose rivets]

Thanks so much for the links. Of all the info that I could have wished for on this facet of the malaise, this was the one.

I will read it [and the other] carefully in the light of day. R

[No Mate!]

I'll have one in the morning.

[Fw44]

The discussion and links here have been very interesting.
Someone I know has held a Class 1 for 20 years and says that once a year or so she gets zig-zags in her vision for maybe 15-30 minutes but that they don't affect anything and there's apparently no headache, nausea or sensitivity to light. She doesn't take medication and has never reported it as migraine because she's confident that it isn't - presumably she isn't alone in this(?)

[Loose rivets]

I have an acquaintance that started having Zig-zags at about age 50. They seemed to take over when she stopped having [roughly monthly] very bad headaches. The early ones were called, by various people, ‘Menstrual migraines' for obvious reasons, but I was never sure that this was a correct term. The later ones cause almost no inconvenience.

A word of caution though. At the time of the Zig-zags, there may be some patches of blindness which are hard to detect. Great care must be taken to test for such blind areas, which of course will travel. I suggest increasing the scan frequency while driving or flying.


http://www.intelihealth.com/IH/ihtIH/WSIHW000/20933/8480/366022.html

[wingnut-will]

I dont know what bearing it has on Civilian flying, so I'll just post it here as a matter of interest:

According to the US Navy's medical annexes recurring migraine or history thereoff, is considered disqualifing for all aviation duties. I dont know what the take is for Class 1 is though. Might be something similar. Temporary blindness is definetly not good for a pilot.

[Loose rivets]

I have mentioned my feelings on pilots being prone to classical migraine several times. More than a couple of attacks in adolescence, and I would say ‘no go.' Brutal, but there it is. In the early 60s, I read that a migraine sufferer could not even hold a PPL.

I mentioned that in the days where crew would drink together into the early hours, confessions...of various types, would slip out. I was obvious to me, as the relative of a sufferer, that they had had an episode. I have always thought that just having a couple of attacks a long time ago, leaves people with the same risk as a first-timer.

The notion that being over 45-50, will ensure not having a first attack is false. "We wheel them in here on a daily basis" or words to that effect, by and Essex eye surgeon. However, these folk may be mostly ‘optical migraine' or Zig-zag, sufferer, and not likely to be disabled.

A full-blown attack is totally disabling, there is no other way to describe it and the onset may be dangerously subtle. The blind patches, as with Zig-zags, can be difficult to detect in the first moments. If a person that you are looking at has no head, then it is obvious. If there does not seem to be any traffic at a junction, then this is not so obvious, because the brain is busily painting in the areas that are not supplied with data. Once the auras and flashing has begun, then it is of course, obvious.

The ensuing headache and sickness can be so severe, that the patient has no ability to look after themselves, let alone and aircraft. It can be an horrific illness, and hope for a total understanding and cure, has for years been ‘just around the corner'.


______________________________________________



I have been aware for a long time, that there is a link between migraine and strokes. I had come to the conclusion that the cause was a direct result of the initial ‘clamping' being so severe, but frankly, I don't know.

I'm loath to bring up the correlation because of the concern that it may cause migraine sufferers. The statement in one of the American forums was frightening. " More deaths are caused in the US from migraine-related strokes, than from firearms."

I was inclined to dismiss this statement, partly because it could take into account the very old and difficult to differentiate, but there is one factor that tallies with ‘my' hypotheses. If the brain needs a quick-release mechanism, to undo what it has deemed necessary in the first place, ie clamping, then it must be because it is a very dangerous reaction, despite being self-induced.

There is a dearth of empirical data on this, and I have mentioned, at length, in the past why researchers have such difficulty in structuring such models.

[GSXR1K]

Hi there,
i have also suffered from migraines in the past.

I was getting ready to start a PPL course next month, but got worried about this condition enough to seek info on flying with it.

In my case, it starts with a bad feeling as to wether a small blind spot that i have noticed was caused by some light reflex that hit my eye, or wether it´s been sitting there for a while and has been growing larger.
Again in my case, around maybe 98% of times it´s the former, and of the other 2%, maybe 1,5% of times it eventually goes away. The other 0,5%, if left to it´s own devices, will start to spread to a point where most of what i can see is colloured lights that obstruct maybe 70 or 80 percent of my vision (on the really bad ones).
It never made me totally blind as in not being able to see where i was going at all, and the time it takes for my vision to clear is a few minutes (could be 15 or 20, can´t really remember exactly), followed by blood pressure dropping quite a bit and then, a few minutes later...vomitting and huge headaches, lasting hours and hours, a real aggony.

Of the things i realized that could trigger it, it came down mostly to drinking a lot of water after heavy exercise. When i was younger (i´m 38 now, and my first migraine must have been at around maybe 12 or so) i thought maybe nerves, along with a physical activity, had something to do with it too, but i´ve since earned parachute wings and raced motorcycles, both of wich have a huge emotional charge attached in terms of the state your nerves are prior to getting on a plane you know you´re not gonna land inside of, and getting your leathers on to get on the racetrack and then waiting for that green light. Both are moments one wishes one didn´t have to go through, so to speak, and both get your circulation going quite hard.

I never suffered a migraine doing any of these things, and haven´t had one in quite sometime, like waveydavey mentioned in his case too.

The good news is, there´s a drug i can take (i never ever go anywhere without it!) and it has stopped develloping migraines everytime.

I´m thinking if i take a couple of these tablets (called "Avamigran") into the aircraft, along with a small bottle of water, i can stop a migraine developing as soon as i notice it, should the worse happen.
As i said before, these tablets have stoped migraines 100% of times in my case. After taking one or two tablets, the sight affecting lights cease after very few minutes, and it never even reaches the point that i would feel any blood pressure drop, let alone nausea and headaches, thankfully!

To be on the safe side, i´ve even taken one of these tablets prior to getting on my motorcycle for some races, even though there were no signs of a possible migraine develloping, and i haven´t noticed any side effects that could be dangerous to me flying an airplane.

So, even though i hadn´t thought this could stand in the way of me flying (my father was a jet fighter pilot, BTW, and i´ve loved airplanes since i was a kid, though less than perfect eyesight prevented me from possibly joining the Air Force), i did get worried about it, as mentioned, and would appreciate any thoughts anyone could give me on wether i should drop the idea of flying, even if only private flying, or not worry about it, since i have a (up to now) 100% sure way of defusing the situation.

Sorry for the long text, and thanks to anyone who had the patience to read it till the end...:)

[wingnut-will]

Well, the problem with pills is that they may make you drowsy or something like that. In fact, a pilot is ordered a course of pills by a GP, it is the pilots responsabillity by law, to inform his AME. You might want to consult with an Aero Medical Examiner in your area. If he gives you the green light, go for it!:ok:

[GSXR1K]

Thanks, wingnut-will.

I´ve just read on one of the links provided above by waveydavey(http://pn.bmjjournals.com/cgi/reprint/4/6/322.pdf) that suposedly if you haven´t had a migraine for 3 months you can get an Unrestricted Class 2 medical, wich is the one i´m focusing on (for now, at least).

If there hasn´t been a an episode of migraine for over one year, you can even get an Unrestricted Class 1, apparently, wich is very good news, as i can´t even remember the last one.

So, i´m not grounded yet :)

I´ll mention the pills to the air doc, and given that i have had plenty experience with those pills over the years and never felt any noticeable side effects, i hope i´ll be ok.
Thanks again.

[Loose rivets]

Your symptoms are indeed ‘classical', and the pills are a ‘Linus blanket'...a comforter, that will no doubt take away some of the reasons that you have migraine in the first place. Deep worry can include the fear of an attack. So, it can be a snowballing downward spiral for some people. A prop, like a good drug, is a God-send and takes way that part of the problem.

I'm convinced that cheese and chocolate play a role in many people's vulnerability.

http://en.wikipedia.org/wiki/Tryptophan

I usually only get my data from published papers, but because I have some strong opinion about this problem, that is not covered by good science, I am resorting to links like the one above. So, I can't vouch for Wiki, but it spells out some points.

Again I would be interested to hear if the reaction to a high workload exercise was to do with a leaky heart. Remember, there may be no symptoms.

I doubt any exciting activities will trigger an attack, usually intense interest in a subject is a good plus factor for avoidance.

The problem that you have, is that in some time...perhaps tens of years in the future, you will go through one of life's little tests. My pal had a marriage break-up and this brought back the problem for him. Long periods of court cases, ill will, and the loss of years of work in terms of his finances, and the migraine started again. So counter productive, and just when you need all your emotional strength.

Unless it specifically states doing so on the data-sheet, I would earnestly advise you to refrain from taking the drug as a preventative measure, if for no other reason than it may reduce its efficacy when you really need it.

[GSXR1K]

I see what you mean about taking the pills as a preventive measure. You are correct in that it takes away a lot of the stress that the fear of having a migraine at difficult times provoques, but doing so often probably takes away some of it´s effectiveness in a real crisis, as you´ve also mentioned. Doing so everytime i went up alone would not be a good idea, surely.

As far as any heart condition, i´ve been doing ECGs for many years, on a yearly basis, and last year did a running one (for around 15 minutes) and no problem at all showed up. I have no idea as to wether the problem you mention would show up in such an exam or not.
This cannot be used as a definite, but motorcycle racing (even at a amateur level, like mine) entails very high levels of physical and mental stress, and i´m gessing if i had a serious heart condition i´d possibly not be here by now, but stranger things have indeed happened (such as Pro athletes dropping dead on a playing field all of a sudden), so who knows?!

Providing the doc says it´s ok, i´ll just keep the "Avamigrans" in hand (as allways) so i can use them if i need too (taking two pills has stopped the symptoms developing into any sort of dangeours levels of visual impairement everytime it´s happened, wich hasn´t been often at all, thankfully).

Thanks.

[Loose rivets]

Ha! Just realized the significance of your title. If you look at the pix of everyone, you will see that I am aware of the adrenaline rush that bikes can give. However, as I say, this type of stimulus is not usually causal.

[GSXR1K]

Can´t seem to find those pics, but i´ve just seen in your public profile that you also ride bikes :ok:

Hope i can also get to do both things : ride motorcycles ("couldn´t live" without them) and fly airplanes.