Vestibular Migraine / MAV

[Nylock]

Hi all,

Enquiring if anyone has any experience / information with regards to vestibular migraine and certification to a class 1 medical standard?

Also particularly interested if anyone has been diagnosed with vestibular migraine and managed to maintain their class 1 medical?

I know that this is a relatively rare and the condition is not well understood - but if anyone is willing to share their information or experience I would be very grateful.

I check PM's regularly.

Thanks.

[Nylock]

Anything? Anyone?

[mad_jock]

The clinical presentation of vestibular symptoms that often correlate with migraine3 includes—but is not limited to—dizziness; motion intolerance with respect to head, eyes, and/or body; spontaneous vertigo attacks (often accompanied by nausea and vomiting); diminished eye focus with photosensitivity; sound sensitivity and tinnitus; balance loss and ataxia; cervicalgia (neck pain) with associated muscle spasms in the upper cervical spine musculature; confusion with altered cognition; spatial disorientation; and anxiety/panic.4 - See more at: Vestibular Migraine (a.k.a. Migraine Associated Vertigo or MAV) | Vestibular Disorders Association (http://vestibular.org/migraine-associated-vertigo-mav#sthash.OQZssBF3.dpuf)

As a none doctor I would say your chances of getting a class 1 are pretty slim.

[Nylock]

Yes as I am finding out - Class 1 is now gone. Doctors and specialist advising realistically no prospect of return.

20+ years of experience and a career gone in the flash of a pen. Going to miss my 18 wheeler....

[mad_jock]

Again none doctor!!!!!!

Go and speak to a dentist and make sure that your not suffering from some sort of jaw/teeth problem.

A lot of that you can get from needing your teeth sorted out with deferred pain etc.

I have had some of those symptoms for about a month before a tooth split. After it got ripped out not a problem. The dentist reckoned it was clinching my jaw while doing the IR rating linked to a slightly high profile filling.

Worth a shot...

[Radgirl]

I agree with Mad Jock but would go further. A dental check up is a simple first stage - should include bite views (X rays) - but you then need to see a specialist in facial pain. This is a fast moving and very complex specialty with much mis diagnosis, and unless you are entirely confident with the expertise of the doctor who made this diagnosis, you should ensure the validity of the diagnosis. Many causes of pain are indeed compatible with a class one.

[MaximumPete]

Seek the expert advice that has been suggested here.

How do find the expert is the difficult bit? Try BALPA or the Hon Co of Air Pilots

[Nylock]

Thank you all,

I was referred to a neurologist who provided the diagnosis. Due to the obvious gravity of the diagnosis, I sought a second opinion that was also in line with the first. Both of the neurologists' particular interests are in migraine and balance issues.

It terms of diagnosis and investigations (and process of exclusion) I am very confident of the diagnosis.

Unfortunately I can see no way out of it. Class 1 has been cancelled and more than several doctors (including the authority panel) are backing it.

Sought every bit of medical specialist advice I could find. I have tried every avenue that I can think of. I have done everything I possibly can. I was hoping that there could be another answer - but it appears that acceptance is the only answer on this one.

In any case - thanks kindly for replying.

[MaximumPete]

Sorry to hear that.

Good luck for the future

[mad_jock]

I would still go and see the dentist and get the shots done.

Something has changed if its just appeared.

Remember as a kid a lad at school suddenly started getting epilepsy and the epilepsy docs where straight in with that diagnosis.

5 years later a visiting family friend from NZ MD was asking about if the Brain scan had shown anything etc. What no scan?

They paid for one privately and bloody great tumour was found.

The docs don't like dentists for some reason. The guy that ripped that tooth out of mine was a hospital dentist type would as far as a could tell was basically a mandible ortho surgeon linked with being a pain specialist. He was contracted by my dentist to do all the extractions, wisdom teeth and the like which he removed three of mine in the one sitting in 45 mins under a local.

Old George said he had through out his career had his doubts about these hospital types and their snooty superiority. That lad had been short of cash and approached him to get some extra work. Two sessions later he was doing all the extractions and wisdom teeth. George who had been a dentist for 30 odd years said he felt like an amateur watching him. And his post extraction complications list was 10% of what it used to be.

[Irish21]

Nylock I sent you a PM with more info, this info just for anyone else reading your post. I am sorry that you have lost your medical...that is a hard one, all of our worst nightmares...keep your chin up and research the things I posted for you, I know they will work!! Take care :-)

1) could be an issue with your ear crystal called "Benign paroxysmal positional vertigo (BPPV) is a disorder arising in the inner ear. Its symptoms are repeated episodes of positional vertigo, that is, of a spinning sensation caused by changes in the position of the head or virus.BPPV is the most common cause of the symptoms of vertigo"

a virus or improper head movement can unseat your ear crystal..it's very common...for me it felt like I had sea sickness for weeks. To fix this issue a doctor has you lean over and he adjust your head to reseat the crystal...not all doctors know how to do this..so ask if he/she is familiar with this method. Once the crystal is reseated your symptoms go away very quickly. Find a good ear, nose, throat doctor for this.

2) could be food issues = allergies = eliminating specific food usually wheat, flour, sugar, milk etc. books like "eat to live" are good for this. Also google celiac disease = food issues = European descent have high rate of celiac disease

[Irish21]

Nylock,, these are the symptoms of Benign paroxysmal (ear crystal unseated) they look very close to what you were diagnosed with are these what you are experiencing?

Common symptoms of BPPV are: an illusion of motion, nausea, vomiting, sweating, mild hearing loss and blurred vision. Stress and insomnia can exacerbate these symptoms.

Many people who experience vertigo have benign paroxysmal positional vertigo (BPPV) — a condition in which a person develops a sudden sensation of spinning, usually when moving the head. It is caused by a disturbance within the inner ear. Feels like car/sea sickness.

[RatherBeFlying]

I had an episode of this. Putting my head on the pillow had me throwing up. I had to be careful with head movement over the next couple days. The onset was over a few hours.

After that, no problems.

So most likely an infection.

As before mentioned stuff can accumulate in your semicircular canals and postural exercises may be able to alleviate that.

[Nylock]

Thank you all for your suggestions and PM's.

I greatly appreciate everyones input and shared experiences.

Just to sum up a few areas - as it appears that Vestibular Migraine or MAV is more towards a process of exclusion with some definitive elements.

Regarding some things that have been excluded in my case include BPPV, Minieres, Labarynthitis, TMJ, accoustic neuroma, MS and perylimph fistula (without dissecting it all).

In other words - both neurologists are very confident of their findings, ENT has ruled everything else out (he is as good as they get), several Av med doctors have gone into good depth of it all as well. It also helps that my old man is in medicine and has been on the case as well.

Unfortunately, what this means is that one is unable to hold a Class 1 due to frequency of migraines or headaches with migrainous features and the simple fact of vestibular dysfunction associated with these.

On a personal note - if anyone down the track comes across this problem I can tell you from first hand experience it is a "rollercoaster". The hardest part for me has been acceptance of the condition. This has involved me doing all the chasing and digging around, hitting old study papers and new journals alike to dig for more information.....to come up with the same conclusion as the neurologists. Letting go of the controls is also being hard - as the flying is integral function in our lives and routine. I know it does not define who I am (unlike some I worked with), but rather is a strong passion. Learning to deflect this in a new direction.....is well....defining of ones character! It would be easy to sit on the couch and fall into depression - but quite frankly ones time is finite. We all have an ending. So no time to waste!

[Irish21]

Areas to investigate for migraines:

1) vitamin/mineral deficiency especially B's (all B's), D, Magnesium, folic acid, Cooper & Iron. get tested asap for these vitamin/mineral deficiency along with full panel.

Migraines could be triggered by vitamin and mineral deficiencies. Before taking additional supplements to treat your migraines, speak with your primary health-care provider.

Deficiencies of folic acid and B-12 are associated with headaches and migraines. Deficiencies of folic acid and B-12 cause pernicious anemia. When severe enough, it can trigger migraines as a symptom, in addition to fatigue, memory loss and irritability.

It is estimated that 1 in 3 adults are deficiency in B's, D, and magnesium without even knowing it or end up with a wrong diagnoses from a doctor when in fact they are only vitamin/mineral deficient.

Symptoms of vitamin B deficiency that also occur with migraines include:

Painful tingling and numbness in the extremities, including the hands, fingers, legs, feet, and tongue
Chronic fatigue
Brain fog
Headaches
Dizziness or vertigo
Depression
Anxiety
Muscular pain
Muscle spasms or twitches
Vision impairments

google: migraines vitamin deficiency

epson salt baths is one of the way to get magnesium back into your body (check with a doctor before trying the epson salt baths/epson salt can be purchase in your health/beauty section of your grocery store/very cheap to buy). Veggies/nuts/seeds are the best way to flood your body with vitamins ie vegan diet for a month.

2) hormonal imbalance. It's a myth that only women experience hormonal changes starting at around 35 years of age and old, men too experience hormonal changes/imbalance with age. Hormonal changes/imbalance causes headaches/migraines. Hormonal imbalance can be caused with age, continual stress and poor diet (ie pilot's travel life style). Get tested for hormonal imbalance. Balancing hormones again is easy with a healthy diet change and possible hormonal replacement.

google: hormonal imbalance headaches (then with migraines)

3) toxics in the body can cause migraines...from food to chemicals. Exposure to house hold cleaning products, molds, new car, paint, working in a hair salon, lawn chemicals all can cause brain & body issues. One of the first signs of exposure to toxics is a headache or continual migraines. Get tested for mold exposure also as it is a major toxin to our body. The best and most effective way to eliminate toxicants in your body and eliminate all of your health issues is through a vegan diet. There are countless books at your library/big book store on how toxics make you sick and how to detox your body of these very harmful toxins.

4) **Food allergies. This is the most common cause of headaches/migraines. Four, sugar, wheat, orange juice, wine, etc are the most common food allergies for people. A vegan diet for a month will detox your body and flood it with much needed vitamins/minerals. Dr Fuhrman, flemington, NJ is extremely knowledgeable about detoxing your body with a healthy diet if you are looking for a doctor, he has article on the net regarding this area. Celiac disease is one of the most common food allergies issues, there is countless reading material on this subject on the net plus countless books on how to change your diet at your library/book store. European descendants have a high rate of Celiac disease. The fix is to change the food you eat.

4) bacterial/viral infection..such as strep throat. Some people do not develop full symptoms of an infection but do develop headaches...have a doctor do a culture of your throat/ear. Pilots/cabin crew are exposed to high levels of bacterial/virus just like doctors/nurse can can become carriers of health issues like tb, strep etc without full developing all symptoms until their immune system becomes compromised ie stress, poor diet, lack of sleep etc.

5) Adrenal Fatigue. Poor diet & continual stress (pilots life style at work) causes issues with our adrenal glands including fatigue. Our adrenal glands regulate our blood pressure, blood sugar, cortisol & adrenal levels and over 50 hormones including all the male/female hormones. They are a big deal but are often over looked by doctors as the root cause of health issues. To heal your adrenals you need a good clean diet, plenty of rest & relaxation and sleep. It is estimated that 80% of adult will suffer from adrenal fatigue sometime during their adulthood.

google Adrenal fatigue symptoms.

6) Thyroid issues. Thyroid issues/adrenal fatigue go hand in hand. Changing your diet can help improve this condition greatly.

7) Ear issues see ear, nose & throat doctor. Ascending & descending week is hard on our ears so it needs to be investigated. A crystal in the ear that has become unseated due to infection, aerobatic flying or position change such as turning over on a pillow or as extreme as biking on a rough trail. This is actually very common and one of the signs is the feeling like you are car/sea sick.

8) Altitude sickness (sign of Hypoxia) If you are experiencing headaches/migraines while flying then the cabin altitude could be affecting you just like people who get headaches by going on a ski vacation in the mountains ie altitude sickness. What does a pilot do about this? Get back in shape...ie exercise, loss weight, breath the on the oxygen mask.

Keep a journal of when you get your headaches, migraines ie what food you eat, does it happen a flying vs home, while under stress at work (ie bad weather, atc delay) or not. Over a months time of keeping a log you should be able to determine the pattern of when you are experiencing your headaches/migraines but most importantly what is causing them.

[Head spinner]

Hi Nylock

I feel your pain, I have been though what you are going through! My username might indicate that!

I lost my medical in very similar circumstances. It took me two years but I got it back. It cost quite a bit of money but it was worth it. In the end I was treated by a world renowned authority on vestibular matters! It all worked and I was eventually allowed back with a multi crew restriction.

I am quite busy but I will PM you some details. I would very much recommend seeing the professor I did. If anyone can save your job she can. If nothing else for a while I found the vertigo rather unpleasant and I was glad to be treated successfully.

I understand what you are going through. It was hell for me and for a while I was really down about it but I took the same approach as you and I worked and fought to get back and that kept me going!

I learnt quite a lot about it along the way so I will try and help you as much as I can but it sounds like you will know as much if not more!

[peacekeeper]

Hi Nylock,

Sorry to read of your situation. I hope something improves for you.

Since there seem to be a few stories of vestibular problems on here, I wonder if anyone has experienced similar symptoms to me. Whilst on the ground I have no signs of vertigo but whilst in the air I feel a fairly constant gentle right hand bank despite the instruments saying otherwise. I've currently been off work for four weeks and am waiting the results of an MRI.

Any thoughts much appreciated!

[Mimpe]

Nylock the Neurologists are probably right, and the kicker is the frequency of the attacks and the sudden onset of the symptoms, and their aviation risky nature. - thats the part that has the aviation doctors having to exclude you.

What interests me most is how you flew commercially for 20 years and then suddenly came down with the condition.

What was it about your pathophysiology that has led to the problem occurring now? Unfortunately if they can answer that and help you, the diagnosis still hangs over you. reversible causes of vasospasm, postural effects of neck position, unequaised pressure effects and so on...quite a mystery.

[Ida down]

Nylock, do not give up, by all means find another way of earning a income, but many have returned, including me. I started getting dreadful headaches, dizziness, vertigo, feeling sick, and had been flying for 25 years. All headscans showed nothing abnormal, and yet it continued. I had to stand down from flying, and then it stopped. So notified the company did a Sim, and was back in business, after seeing the company doctor. (TAA, Australia). All was well, until................. at TOC, one day, I noticed the F/O looking rather oddly at me, (not unusual) but this time he had alarm on his face, and suddenly I saw why, my left shoulder was fast becoming covered in blood, dripping from inside my left ear. As it was only a quick sector, we carried on, me moping up the blood, and he flying, and it was a relief to get on the ground for both of us. Went to a GP in Melbourne straight away, he, alarmed, sent me straight to a hospital, (I was still dripping blood) and they finally found the cause of my awful problem. A piece of filling had entered my nasal tube, and each time the A/C got to a certain height, it would appear your tubes close slightly (I never did ask where else did this happen in your body, I did not want to know!) and the filling would cause bleeding inside the area that runs between the ear and the nose. (I am medically inept, even though am married to a nurse) so cannot tell you the medical terms. Anyway I amused the ENT bloke, and returned to flying, clutching my clearance in my hot little hand. And I thought I had had it, both in flying and in life. Keep flying privately if you can afford, share with a mate, keep yourself fit, and you might find your time on the ground, might not be for life. Good luck, mate.

[Nylock]

Firstly - I would like to thank those who have PM 'd me with their experiences and some success stories. I very much appreciate the willingness to share, along with the concern and thoughtfulness that people have shown to me - yet do not know or have not even met me. A word such as "generosity" comes to mind - so thank you all.

What was it about your pathophysiology that has led to the problem occurring now?

I have absolutely no idea! Maybe just getting old (just hit over 40).....you know a few stray grays (I call it blonde) speckles in the hair! Nothing else has changed that I am aware of. In fact, life was going along better than ever on all fronts.

Neurologists are probably right, and the kicker is the frequency of the attacks and the sudden onset of the symptoms, and their aviation risky nature. - thats the part that has the aviation doctors having to exclude you.

Yes - afraid that is so.

The medication has helped gently in terms of frequency and intensity of headaches - but a constant base line of disequilibrium / fog in the head persists. Degree varies - sometimes to the point I do not drive a car, some days kind of reasonable - but never back to normal.

The medication has slowed me down incredibly. Even if the meds fixed the problem - I think it would be difficult to fly whilst on some of this stuff.

I do have to say - the life changing events between losing my job at work and redefining my role within my family has been a very stressful time - probably the most stressful thing I have ever done. Especially with an uncertain future. As has the concept of accepting a diagnosis without a scan or pathology report to point at.

In any case - not giving up - still working the problem.

[Ida down]

Onya mate, its not going to kill you, and to beat it is the ultimate, then that great day you present for a Sim, is coming your way. (Well if there is such a thing, as a great day for a Sim, but in your case???) Family problems I understand, I was a 89er in Australia, the day we all lost our jobs, and what happened afterwards I hope no pilot should ever go thru again, but new things happen in medicine every day, and don't be afraid to try alternative medicine, remember medicine in Asia is a thousand years older than western medicine. My missus is a triad nursing sister, and yet she believes in Asian cures as well. Try everything, and never give up. All the best mate.

[Nylock]

Thanks Ida.

I still recall one of my first looks at the flight deck was on a TAA DC9 on the way up to Pros-vegas. Totally awesome. Then next trip as a young guy on TAA the guys let me sit in the jump seat A300- BNE to SYD. Watched as the speed bug on the ASI dropped back to 250 kts without anyone touching it.....had me stuffed! Little would I know 15 years later I was doing the same trick on a 767!

No giving up.

[Ida down]

DC9. The pilots aeroplane. The noisy,dirty, beautiful little girl, so loved by all who flew her. Untrustworthy, skittish, sexy, and loved spewing stuff all over the sky, the Greenies nightmare. Don't get me started.

[Radgirl]

Orthodontist..........snap.............

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