View Full Version : Migraine question


teropa
15th Apr 2007, 17:45
Hi all!

I have read PPrune for many years, and even debated here for some years ago :}. I have a very high regard for the opinions of the people who post here.

Now to my Question.

I am now 27 and was diagnosed with Migraine when I was 21. After continuing my studies after a year in the military I started getting migraines
with a visual aura. The aura is like this: first I get a hint of having a very very small blind spot somewhere in the field of vision. At this point I am sure I'm getting a migraine. This tiny blind spot (called scotoma) lasts for about 1-2 minutes, after which it gradually starts to form to a migraine "worm", which is a bright zig-zag kind of form with rainbow colors. All that is "underneath" that bright form is also "a blind spot" at the same time. This form then grows for about 10 minutes, and then starts to dissipate in a way that it starts to move to the outer edges of the field of vision, only to disappear completely after about 20-25 minutes. Right after this, even though I can see everything, the eyesight is somewhat "vague" in the areas where the scotoma was present. In about 1 hour I'll be completely out of the migraine attack. I don't get bad headaches after the aura, nor do I get any nausea.

So there you have a description of a migraine with visual aura. I get these attacks more during the spring when there's more light (about 1/month or less). And maybe ~ 10 attacks / year.

I have used migraine-specific medication for the attacks, and also Ibuprofen in large quantities (my spouses sister is a neurologist, and she tells me to take 800-1000mg of Ibuprofen for the attacks, which seems to do the trick, and I feel normal once the visual auras have stopped).

HOWEVER, Just recently I used plain vanilla ASPIRIN for my attacks (had nothing else available), and to my astonishment something weird happened. I have taken the aspirin immediately as I see the small blind spot. What happens next is that the blind spot starts forming into the migraine "worm", but then the worm just goes away just like that. The migraine attack lasting for about 1-3 minutes total. After this I don't get anymore of the visual aura or any headache. No symptoms at all.

Now, my fantasy of becoming an airline pilot went down the drains at 21 when I started getting these migraines. And the PPL went the same route, as migraine with aura is forbidden in JAR rules.

My big Question is this:

IF my success using Aspirin with migraine continues, and that I can clearly deduce that visual auras and migraine attack STOP when using Aspirin, Would it be OK to:

1. Just not tell the AME about any migraine symptoms when applying for medical certificate (there are no records of me being diagnosed with migraine anywhere), and just go on getting the PPL and trusting the medication (given that it really works, and from a longer period of "testing") ?

2. Tell the AME about the attacks completely honestly, and hoping that the new medication and its effects on my migraine would have a positive effect on my medical ?

Don't shoot me for thinking about #1 as an option. I've dreamt of becoming a pilot since I was 8 years old, so that's almost 20 years. I am heavily involved in many kinds of aviation related stuff, but don't have a license. I have problems in accepting that I might NEVER get certified to fly. :{ :{ :{
Interested to hear your opinions. Thank you in advance.

regards,
Tero



Loose rivets
15th Apr 2007, 19:01
I have written several pages on this subject over the last few years. Frankly, some of it is a bit frightening, but the severe episodes are usually associated with migraine that causes large areas of blindness, followed by severe headache and sickness. I doubt that this applies to you.

I talked about late night conversations with aircrew who, after many drinks, would confide in their colleagues about quite personal matters. It was obvious that some of them had suffered migraine. It was obviously festering in their background thoughts all the time.

Zig-zags seem to be a type of migraine that often starts in later life. It is also a type that is often not very severe, however, as you say, the visual areas that were affected remain ‘vague' and this alone means that the visual processing in those areas is not reliable.

The problem is, that flying is utterly reliant on eyesight. Even a small disturbance could be critical on a dark and stormy night. Someone recently wrote on this forum about always fearing the onset...always checking if a blind spot--caused by a reflection in the intense light at altitude–was the first migraine blind-spot. It sounded like an ongoing mental torture.

Do a search for my postings, if no luck let us know and I will look for my notes.

I'm now not so convinced that day to day stress in not causal. Deep underlying worry was, I felt, the main cause, but now I'm not sure. I'm still fairly sure that chocolate / cheese / turkey etc can trigger an episode, despite there being a need for two other factors in the brain chemistry to allow Tryptophan http://en.wikipedia.org/wiki/Tryptophan to cross the blood/brain barrier. It all gets rather complicated at this point, because the main symptoms of migraine are caused at the dilation stage, not the initial constriction.

It is my belief, that if one could stop this natural constriction, the problems would go away.

Your life at the time of the onset is indicative of the cause. Deep relaxation may help. In some cases there has been a suggestion that simple imagery of the brains blood vessels, opening and allowing more flow, can stop the constriction/clamping in the first phase.

Albert Driver
15th Apr 2007, 20:24
An interesting post, Tero, particularly your experience with the use of aspirin in reducing or terminating visual disturbance. I've heard of others who have had the same success with low-dose aspirin (you didn't say what dose you took).

This begs the question: if taken regularly, could low-dose aspirin be effective in reducing the incidence of visual disturbances or even eliminating them altogether? A quick Google shows one current medical trial taking place but I couldn't find any published results.

DX Wombat
16th Apr 2007, 19:08
Teropa, somewhere I have seen an article which says that if you have been migraine free without any treatment for five years then the CAA consider it to no longer be a risk. It may even be on the CAA website itself. Unfortunately I can't find it at the moment but if I do, I shall post the link for you. However, I'm not sure how it would relate to the regulations of Finland's equivalent of the CAA.

teropa
16th Apr 2007, 19:22
Thanks guys for all your comments.

LR: I've read your posts on the topic extensively over the years. Thank You for all your contribution on the subject :).

Albert: I took 2 x 500mg tablets (500mg is the smallest size tablet). For normal aches it says on the package for adults to take 1-2 tablets. For migraines usually the double is called for, but I elected to just take two. I've had aspiring stop my migraine now twice, with equal results. I shall await now to get migraine again :} :} , to see if the effect remains...

DX Wombat: I'd be very interested to see the information, if you could locate it somewhere still ?

cheers,

Tero

Blues&twos
17th Apr 2007, 22:54
For what it's worth - I used to suffer migraine with aura when I was a kid, right up to several years ago. Exactly the same symptoms as described except I got a blinding headache behind one eye and was frequently sick once the aura went away. Lasted about 2 hours. Curiously on a couple of occasions I was unable to speak properly either - I knew what I wanted to say but completely the wrong words came out....very strange. (e.g. "I don't feel well" once came out as "I don't rabbit")

I also used Ibuprofen successfully to relieve the pain, but have never tried the aspirin thing.

Not eating cheese, making sure I got plenty to drink and keeping cool pretty much completely stopped my migraines overnight.

Now the important stuff. A number of years ago I was in the unfortunate position of having a migraine with aura onset whilst I was driving in the outside lane of the M25 late one night. I was doing about 80mph. It was terrifying. The disturbance to my vision was completely disorienting (the aura affects both eyes) and I had to make my way across 4 lanes of traffic onto the hard shoulder with big blind spots where I was able to stop safely and get my roadside recovery people to collect me and take me home.

Now imagine that in an aircraft.....don't do it.

pulse1
17th Apr 2007, 23:44
teropa,

Interestingly there does not appear to be any reference to migraine on the DVLA Medical Standards on Fitness to Drive http://www.dvla.gov.uk/media/pdf/medical/aagv1.pdf

This is the basis for the medical requirements for the NPPL and implies that you could get an NPPL as a migraine sufferer. As you cannot fly at night, the visual impairment would not be so serious.

Best of luck.

teropa
18th Apr 2007, 04:53
Blues & twos,

Interesting story. And you haven't had one migraine attack in years now, after making the changes you mention? Do you currently have a license of some sort (PPL ?) ?

pulse1,

Sounds interesting! I would hazard a guess that they have overlooked something in those medical specs, since one would think that migraine even during daytime would be a no-no. I've heard about NPPL for many years now. Is it already a reality in some countries? (UK?) I live in Finland. Is it possible that Finland could get its NPPL someday? Currently I think it's not possible to get NPPL here (at least not yet).

Are there any other restrictions to NPPL, other than not flying at night? Does one need a safety pilot of some sort (for example with migraine) ?

Yea, a lot of questions. Sorry about that :).

cheers,

Tero

gingernut
18th Apr 2007, 08:53
Not eating cheese, making sure I got plenty to drink and keeping cool pretty much completely stopped my migraines overnight.

Cheese seems to be a classic "trigger" for many sufferers, alongside coffee, stress, chocolate, red wine, and pre-menstrual tension.

pulse1
18th Apr 2007, 09:59
teropa,

I'm sorry, I didn't notice that you were posting from Finland.
I'm afraid that the NPPL is a UK National Private Pilots Licence and, if you are medically qualified to drive professionally, then you can use all the benefits of a PPL in UK daytime VFR. If you only qualify to drive privately you can still fly solo or with another qualified pilot.

I am in the process of converting my UK PPL(A) to a NPPL as, at my great age, the medical requirements are so much more relaxed. For example, my Medical Declaration from my own doctor cost me £12, compared to the £85 cost of the full PPL Class 2 medical. The only down side is that I will not be able to fly abroad which, with the new requirements for an ELT, I am unlikely to do any more anyway.

Also, if anything goes wrong with me during the year, my doctor will be the first to know about it and will have the right to exclude me. I will not need to inform the CAA which means that they will usually ground you pending a full report from a specialist which, in the UK, can take a very long time or cost you a lot of money.

I think that there are signs that the EEC might adopt a similar licence.

Blues&twos
18th Apr 2007, 11:17
Tero, I'm not a pilot - have just started flying lessons (only had a few). This migraine thing did concern me, although I've not suffered for a long while now. I'll be following this thread with interest!

Oh that's super!
21st Apr 2007, 04:23
Teropa, I'm just curious - does your blind spot -> worms last just 1-3 minutes *in total* after you take the aspirin, i.e. the onset of a blind spot to the disappearance of all symptoms takes just 1-3 min as long as you take the aspirin as soon as a blind spot appears?

rick0
25th Apr 2007, 20:26
Hi all,

I've had only a few proper migraines in my short life but I have suffered from suspected "stomach/abdominal migraines" (basically just alot of pain in the stomch - no flashes in my vision). I take Proparanol/Beta blockers for these and I've been on them for a while - anyone know if i'd be okay for the C1?

Also, I was looking up on the internet about arrythimia and I came across the BUPA website which said something along the lines of "beta blockers can cause arrythimia" - anyone know anything about this?

Cheers.

teropa
25th Apr 2007, 20:45
Oh that's super,

Correct. From the onset of blind spots to their disappearance takes only about 1-3 minutes after I take the aspirin. Before, with Ibuprofen they would last the entire 20-25 minutes everytime... Aspirin has proved miraculous for me at least for now. We'll see if it continues... When I've had 10 episodes, with similar results, I'll believe... not sooner.

rgds,
Tero

Flyin'Dutch'
28th Apr 2007, 00:41
That some people's migraines respond to Non Steroidal Anti Inflammatory Drugs is well known.

Migraines are a no-no for certification by the CAA.

The FAA will certify on a case by case basis, depending on severity, frequency etc.

Albert Driver
28th Apr 2007, 08:04
That is well known, FD.

What is of interest here is that aspirin had such a dramatic effect on reducing the duration of the visual disturbance.

Since millions of people now take low-dose aspirin regularly as a preventative measure for other conditions, is it possible that such use could reduce the frequency of migraines with aura, or stop them altogether.

Has anyone who has started taking low-dose aspirin for other conditions noticed a reduction in frequency or severity of migraines?

gart
4th Oct 2007, 00:37
Most of everything you said about your migraine and your circumstances about wanting to fly are exactly equal to my situation + I'm same age also. Only difference between the two of us is that I wanted to fly military aircraft in the RAF. I went along to the P1 interview when I was 20 and migraines came up! I wanted to fly since the age of 8, but it seemed there was no way round it! I was pretty pissed off!

Like you - zigzag migraine worm, that comes after noticing blind spots (usually I notice missing information in my vision - text is common detector- when I cant read some of it). Half hour - and I'm OK, but feel bit washed out, and I don't normally get bad migraine head aches!

I, like you, felt like not letting it get in the way of what I wanted to do (they have no proof I even have them), but then I thought about the consequences of what cloud happen if i was in the sky and got that nasty condition. The other thing about migraines is that they get worse with stress and bad sleep, something that seems to go hand in hand with the aviation business (civil and military). I was also told I couldn't even join any role as air crew and not even ground role until I was migraine free for at least 2.5 years, something that hasn't happened yet! I get them around 10 times a year or less. If I was in the military, I would probably get them more, as I would be under more pressure!

I'm actually quite worried about them effecting me on the motorway, as I'm getting a motorbike soon!

teropa
5th Oct 2007, 15:28
Hi Gart,

Thanks for your story! I have not given up yet.

What do people here think about the coming EASA regulations and the possibility for a whole new JAR license inside EU:

http://www.easa.eu.int/doc/Press_Room/A-NPA%2014-2006%2001%2007%202007.pdf

Considering that I have migraine sometimes, do you think I would stand a chance at getting a medical with this new license inside EU ?

Tero

GSXR1K
11th Oct 2007, 23:19
I used to suffer terribly with Migraines as a youngster. They´d be as described initialy on this thread, but followed by tremendous headaches and nausea that would last till i had vomited any and all substance present in my stomach, and even then i´d be trying to vomit still for some time (i mean the nausea, as the headaches would go on, and on, and bloody on).

Then i discovered there were tablets you could take to make it better! I couldn´t believe this might actually work! I had even planned to depart this planet had the Migraines gotten frequent...

Well, wouldn´t you know, it did work! That was absolutely bloody marvelous to me, as i used to lay in bed, covered in all the clothing i could gather (so as to face the very low blood pressure that accompanied it, and the extremely cold sweat) for hours and hours, feeling like i could take a knife and poke my eye out so it would stop hurting so damned much.

I remember one episode, after playing a Rugby game, when all my mates were celebrating in the locker room, while i was on my knees hugging a toillet trying to vomit stuff that was no longer there while almost passing out and with huge headaches...

Anyway, after a few years, the condition started to make itself less and less present, till it got to a point when i would go a full year without one. Rather nice, i thought.

At age 38 i decided that, not having been able to do the only thing i ever wanted to, wich was fly jets in the Air Force, just like me pops, i still wasn´t going to die without a pair of wings on my chest!

It got to a point i started being extra carefull riding my motorcycles because the thought of going out without my wings really bothered me.

To make a long and boring story a bit less long, i´m now the proud recipient of a Private Pilot Licence, and have started an Aerobatics course on a Pitts Special (one of the very few airplanes i loved even as a kid, inspite of it not being of the jet fighter variety, and one i now love even more!:ok:).

I haven´t had a Migraine for i can´t remember how long (maybe something like 3 or 4 years) but i never ever go anywhere without my Migraine pills...it even got me a little bit worried that the Pitts Special´s seat belts completely covered my access to them (i lied when i said i had "absolutely nothing" on my pockets, as i knew no amount of Gs would make them leave where they were...), but that only lasted till we went vertical soon after take-off :}

BTW, the pills work fast in ridding me of the symptoms, in a way i believe if i was alone in an airplane and it hapenned, i´d be ok soon after taking them and able to land safely.

There´s allways hope!

PS : Oh, the stress of that first solo flight...checking the placement of the pills for fast one-handed access and so on...good thing flying was allways a very unstressfull thing to me :)

teropa
12th Oct 2007, 06:33
Hi!

What are these magic migraine pills, that do the trick for you?

cheers,

Tero

GSXR1K
12th Oct 2007, 09:07
They´re called "Avamigran".
I´ll usually take two if it´s already developing (say, if it got me 5 or 10 minutes to get to the pills), or one at the slightest sign it´s coming, and have hardly any pain or nausea at all and the visual effects go away after a few minutes.
However, as stated, i haven´t had a Migrain for a long time (thankfully!!!!!!!)