Yes, I would be interested in that as well.
There is some doubt in my mind as to wether the Zig-zags are the same as true classical migraine.
Optical / ophthalmic migraine seems to have some differences, though it is not widely accepted that there is a distinction. The ‘zig-zags' seems to be a type of migraine that would come under the unofficial category of ‘late onset', and my guess is that if a survey was done, these older first time patients would describe zig-zags or similar visual aura; they would not experience the high percentage area of blindness and other debilitating side-effects.
This does not mean that this characteristic pattern does not occur in younger patients.
I witnessed a world authority on migraine make the unambiguous statement "...anyone that has not had migraine up to the age of (circa 50,) was not going to get it." I then talked to a consultant eye surgeon on the subject, and he said that this was manifestly untrue. "They come through that door on a daily basis. It's migraine. "
Now, I strongly suspect that the majority of the latter patients had just suffered their first episode of optical migraine, and that they would be unlikely to have the full and devastating symptoms of classical migraine, but I don't know.
There was a time when sufferers could not even hold a PPL, but I guess that it was realised that many people would never have another episode, so they were no more likely to be incapacitated at a critical moment than anyone else. But the authority of the day erred on the side of safety. Some years later they seemed willing to look in detail at the symptoms of the individual. I have heard so many conflicting stories, the only way would be to go through the whole procedure with the C/J AA. docs.
When it comes to flying, it has to be realised that classical migraine sufferers can be very, very sick people. I am agonizing over leaving the last statement in, but frankly it has to be said. During an episode, they can be virtually blind and rendered totally helpless by violent projectile vomiting and other fearsome symptoms. The following headache has to be experienced to be believed. And this is only the beginning.
Now before I go any further, my advice will be focused on avoiding the malaise in the first place, and not on the ‘fixes' available to ameliorate the symptoms.
During my research, (I use this term loosely because I'm not medically qualified in any way) I have found well written reports on the long term harm that can be caused by repeated episodes. There are dozens of them on the net. At the worst end of the scale, some research indicates that there is a high risk of permanent damage being done to localized areas of the brain...every episode. Tying in with this, another report states that more people die from migraine related stroke in the US, than die from gunshot wounds.
I have no way to substantiate these findings, except that in the few cases that I'm aware of, where the patient has had an MRI, their suffering over the years ties in with "several hyper opacities presumably associated with small blood vessel disease." But then for anyone at my age,(66) I would expect a radiologists report to say much the same thing. So it is a question of surveys relating an early onset of this damage, and I can not find a clear statement of damage vs age.
My gut feeling, is that damage is done in the more severe episodes. However, there is every chance that the effects would be undetectable to the patient.
Even with the brain's miraculous ability to take over the functions of some damaged areas, there would be no possibility that this would be done transparently. Again it is my unqualified reasoning that tells me that these are areas that have long ago been taken out of commission due to repeated localized clamping or spasm. They are effectively dead before they become observably damaged. This way the patient could go into old age without knowing they had been actually physically damaged. Then, should they die of a stroke, it would seem perfectly natural. Only those that have donated their brains to science, would ever be entered into the statistics, and even then I'm skeptical about the possibility of determining the precise cause...except by a large statistical survey.
My feeling has been for a long time, that the damage is caused by the constriction phase, and the symptoms caused by the mechanism that releases this constriction or spasm. In any event the horrible part for the patient seems to be during the dilation phase.
All of this sums up to say, that if you have had one or just perhaps two, slight to moderate attacks in your whole life, then there is a sound argument that this should not be allowed ruin a career in aviation. If there has ever been a severe episode, or a string of moderate ones, then the decision has to be to walk away. The sheer mental weight of going through a flying career with the fear that one day you may suffer a disabling malaise at a critical time, is just the sort of mental baggage that will increase the risk of an attack.
There are no magical remedies, but I'm convinced the patient should proceed along two routes.
First, because it is the easiest, eliminate certain foods. Remember, at this stage all we are trying to do is to reduce the symptoms a little to get started. However, as I mentioned in an earlier posting, it is difficult to determine cause and effect because there seems to be an increased vulnerability at certain times. So, to eat cheese at some points in a given year might trigger an attack while at other times, it will have no effect at all. This makes an impossibility of small statistical analyses. But during a self help period, cheese will be on top of the list. Chocolate the same. Both of these have to be totally eliminated while trying to assess vulnerability. Red wine is another, but at the end of the day all the patient is trying to achieve is a episode-free period to get started with a long term improvement. A good reaction to the cutting out of certain foods will have a double advantage. The worry of an attack is in itself, a long term worry that you would be better off without. This takes me to the other side of the two pronged attack.
Opening up one's mind to deeply rooted worries is vital in bringing relief to any form of involuntary spasm. (By this I mean where there is no neurological reason for the spasm, such as a trapped nerve.)
This may all start to sound a bit ‘alternative', but the self clamping mechanism in the brain's blood vessels is a quite mysterious mechanism. On the one hand it's there to protect against hemorrhaging after trauma. Fairly straight forward, but in addition there are also some more complex functions that I don't understand. An extraordinary function may have been described in an unpublished paper that just happened to be lying on a friends table. It discussed the mechanism by which an evil spell might have an effect on the victim. The severe constriction of blood vessels in the brain were the main thrust of the argument.
It seems that a long term malaise can be inflicted on the victim by suggestion alone. That it works is not in question, how it works has been argued about since witch-doctors first called up evil spirits. Somehow, a suggestion was having an effect that could be demonstrated and indeed repeated.
It is not original thinking to suggest that we are able to burden our own minds in a manner that has this reaction, it is in part what psychiatry is about, but because somehow migraine has been labeled as an ‘ordinary' problem, then for a long time it only warranted ordinary cures.
Now with the blessing of the latest software, we are able to see into these vessels as they constrict. A few days ago I was looking at a CAT screen of astounding resolution. The blood vessels could be isolated totally, and then the inner walls of the vessel were observable as they undulated. This was leading edge technology, but what it didn't do was tell the doctors why a vessel constricts in the first place.
I don't believe ‘stress'–as it is usually thought of--is remotely the same as deep underlying worry. I think it is the latter that causes the problem; accepting and addressing the issue will be a major step in its own right.
Having cut out so called trigger foods is just part of a process of elimination, the real work has to be done at a very deep level. Certainly burying one's head in the sand, is exactly what the migraine suffer should not do. Problems have to be brought out into the open and tackled. Easier said than done a lot of times. Remember you are fighting on two fronts, one the problem itself and the other the terrible effect that is has on you. Leaving things lying buried is potentially very damaging.
I have not touched on the relationship between a leaky heart and migraine, but I would be very interested to hear from anyone that finds they have such a fault. It seems that it can be so small that people can be very athletic all their lives and not know it's there. There is a possibility that a
hormone released by such a leaky heart can cause migraine.
One last comment. While one person makes no real statistical argument, a friend of mine that had terrible migraine while running a company--that was consuming his personal funds at an horrific rate, is a lot better now that he is broke. He is a very fit 67year old, doing sports, running and swimming etc.. He seemed to fit the bill perfectly, the migraine much worse while he was not accepting the non viability of a company he had worked so hard to start up.
However, almost as a warning not to assume anything, he has recently found out that his heart is leaky and it has been like this for most of his life. It is easy to see how coming to a conclusion about one set of data can be invalidated by the unexpected.