Migraine

[Deancross12345]

I know this may be a touchy subject for some people but I am trying to find out what the rules are for Class 1 or 2 UK Initial Medicals at the momment with people who have a medical record of migrain.

I havent had an attack for a number of years now and am exploring all the options for start my aviation career.


Thanks

DCS

[Flyin'Dutch']

DC,

Depends where you want to apply.

FAA can certify fit in certain circumstances.

JAR and CA CAA consider this a disqualifying condition. You may have a hard job convincing that you are fit. Likely to need a report from your medic.

There is no difference for this condition with regards to varying standards for the different classes.

HTH

FD

PS I am not the FAA/CAA so although I do my best to give an answer based upon my knowledge and experience you ultimately have to consult the horse's mouth so to speak.

[Evo]

Has it actually been diagnosed as migraine?

I believed I suffered from migraine for a while - I had a series of fairly bad headaches, and went to my GP who said "mmm, sounds like migraine, take a couple of ibuprofen and sit it out. Next, please" - until I discovered that my computer monitor could be driven at more than 43Hz, interlaced. I switched it to 75Hz and the problem disappeared (although I still hate cr@p monitors!).

I mentioned this to my AME when I first got my medical (the form asks if you suffer from migraine and I guess my medical records still contain some kind of note from the GP - unless it's just 'told him to take a pill and f-off' :) ) and he said that unless you've had a formal diagnosis then you do not know, and agreed that it was unlikely that I had ever suffered from it. The CAA may well refer you to a neurologist to get that diagnosis, but it's worth asking.

Also, if all else fails, what about the NPPL? The medical limits are less strict, so you may well be able to get a sign-off for that even if you cannot get a CAA Class-2?

[Deancross12345]

Thanks for that,

its actually FISO / ATC I want to do which puts a different edge on it I suppose.

Thanks

[Simon_Catlin]

I have just been declared unfit to fly during my renewal of my Class III CAA medical to a JAA Class II.

Migraines. Now I have to be careful what I say as this is ongoing and medical reports are being drawn up, but I mentioned it at the original medical five years ago. I admitted to getting one about once a year, and did the same in this examination.....

Now I've had five years of my PPL(H) robbed from me.

I'll write more here once I know the full score, but the suggestion from the AME, who was extremely sympathetic, was that I am likely to be allowed to do no more solo, although I can act as or with a safety pilot..

[QDMQDMQDM]

It may be worth getting the original diagnosis reviewed. There are very many people out there with a history of being on imigran or its related drugs who do not have and have never had migraine, by any stretch of the medical imagination.

QDM

[Simon_Catlin]

..as I may be forced to see a Neurologist.

By definition there is likely to be an EEG and other tests.

I had one when I 17, but nothing unusual was found. I just now need to wait until the doctors report gets submitted to AME and their report goes to the CAA Medical Arm. This could take months

[teropa]

Very interesting topic.

I started to get migraines when I was 21. I had planned to start a career in aviation then. When the migraines started, it all went to hell...

Now I'm 24, and am still getting them, not as often as before though... about 5 in a year. I'm still hoping that I could get a medical someday regardless, I hope that the episodes will just stop altogether.

Interestingly, I know people who have PPL(A) who also have a history of moderate migraine... they still have the occasional episode of M. Strange that you got your medical revoked because you admitted of having ONE episode a year...

God I'm so ANGRY !! If this has to ruin our flying, I wish it'd just do it so that I couldn't even think about it anymore! Grrrr!

Tero

[hm671]

I noticed a post on the same topic below but it did not answer my questions. Im just about to start my PPL training, reliant on the outcome of a Class 2 medical which I will soon be taking. Im 16 and was diagnosed by a consultant with abdominal migraine aged 7, but have not had an attack for over 3yrs. Could this still prevent me from passing the medical? Also could it prevent me from passing a Class 1 in a few years time as I hope to be able to achieve an ATPL.

Thanks

[ausdoc]

Not sure what abdominal migraine is. They would probably require a specialist report for the higher levels of certification.

[Loose rivets]

I would be interested to know some of the symptoms that led your doctor to diagnose abdominal migraine. If you do not have any of the symptoms of classical migraine, I would make sure that the childhood assessment was accurate.

If you have a violent reaction to cheese, then there is good cause to follow this line of logic.

I posted a rather depressing comment on (I think) 21st of May ish. On classical migraine. I understand now that it is a total bar to holding any licence, though I have been out of the loop since the JAR s came in.

I am- or was- a pilot not a doctor, but have made a considerable study of this subject over many years, following someone close to me being sporadically disabled with this cruel malaise.

[2IC]

Doing a google search on "abdominal migraine" provides lots of interesting links. Doesn't replace a doctor or specialist, but the general theme seems to be that the symptoms of abdominal migraine normally appear in childhood before puberty, reaching a peak at the age of 20 years and thereafter falling rapidly. So maybe the worst is over. One example (http://www.cafamily.org.uk/Direct/a13.html)

[QDMQDMQDM]

Get the diagnosis reviewed. I'm not impressed with it in general as a diagnosis and think it serves as a catch-all for all kinds of non-specific childhood abdominal pain. What I'm saying, in other words, is that with a sympathetic specialist you may stand every chance of getting this blight of a diagnosis ('migraine' is bandied about far too loosely) removed from your record.

QDM

[Evo]

On classical migraine. I understand now that it is a total bar to holding any licence, though I have been out of the loop since the JAR s came in.


Out of interest, what is the situation with the other main type (forgotten the name - common?).

[Flyin'Dutch']

Evo,

As far as I am aware the regulations make no distinction between the various clinical entities of migraine. Some clinicians would say that there are none anyway and that they are all gradations on a continuous scale.

While it is put rather black and white in the regulations I believe there are some nuances, certainly in the way the FAA deal with this issue.

Abdominal migraine is rather a misnomer. It is recurring abdominal pain in youngsters the origins of which are unknown (certainly to me! :D) Looking at a quick google search reveals some (up to scratch?) research which may link abdominal migraines to those in one's head but I think there is not a lot of evidence that this is indeed the case.

Tons of kids get tummy aches while they are growing up and equally a fair proportion of folk get bad headaches/migraines but I think is a rather tentative one. I would be surprised if a history of tummy ache as a nipper would label you as prone to migraines and hence unable to fly.

HTH

FD

[Loose rivets]

First and foremost - see QDM's post - Is it correctly diagnosed? Secondly, what is the empirical evidence that the so-called migraine of the gut is connected to ‘classical migraine'?

I'm afraid that I'm not going to be much help with a definite answer, but I personally feel that there is a connection between this type and ‘classical'. Violent reaction to cheese is an indicator....but that's all. I have not solid data. There is more and more evidence to suggest that something in cheese and chocolate will rapidly affect visual processing, and following this, a full-blown attack of Classical migraine within a day or so. The ‘deep worry' syndrome that is the most likely candidate, becomes inextricably linked with other causal factors.

Kids do get a lot of tummy aches. It seems to be the suddenness from being totally well -to ill, then back to bouncing around again - that marks a Migraine-like factor. Try very hard to co-relate food types with reaction.

Menstrual migraine is supposed to be quite unconnected, and mostly hits females between the age of 12 - 45. It typically follows a 28 day cycle and can be vicious, causing headaches and vomiting - with associated over sensitivity to light: eyesight is otherwise unaffected however.

If anyone thinks they may be affected, but does not have very specific diagnosis, vigorously resist the word migraine being used on any record whatsoever until you are sure.

There is a byproduct of getting drunk with ones colleagues over many years, and that is you learn some of their very personal secrets.

There is no doubt that there are a ‘good few' long-term professional pilots that have had ‘classical migraine' at some stage in their lives. This is potentially a totally disabling malaise, and is a - logical and legal - bar to holding any licence. Classical migraine can cause almost total loss of visual field IN BOTH EYES for just a few mins to several hours.

What I said in May, was that there is a chance that young people, that have only had one or two episodes in their lives, stand a good chance of never being bothered by it again. It is the very fact that ANYONE can develop migraine in later life: that means that any pilot has the potential to be affected by it for the first time while on duty. So, why should someone with almost no chance of a REoccurrence be stripped of their career: are they any more likely to get an attack than someone that has never had one ? I fear the answer is yes, but only slightly more. This presents a kind of argument that they should be allowed to fly, as they are more or less as safe and the average pilot; there is some logic to it: but it has no basis in law.

It is my totally unqualified opinion, that it is not the (natural and protective) constriction of blood vessels that causes migraine, but an agent that the brain produces to re-dilate as a matter of self survival. This idea has gained considerable interest but no funding as yet I'm afraid.

What I am about to say is really out of my remit, but having seen people tacking huge quantities of aspirin or distalgesic, and still lie there in more pain than I care to watch, I'll mention it anyway. Sleep seems to be the one thing that makes an attack fade in reasonable time. My xxxxxx takes Zolpidem, marketed as StilNoct. It's a superb short term sleeper - with no discernable side affects; but this is just an example. I cannot stress strongly enough, that self medication may mask symptoms, and nothing should be taken until the real reason for the problem has been confirmed by the appropriate medical practitioner.

I just wish that I could be the bearer of more cheerful news.

[Flyin'Dutch']

LR,

That is a mighty long post!

I think that you would have done well by putting:What I am about to say is really out of my remit as your opening statement.

You wrote:

Menstrual migraine [snipped] mostly hits females between the age of 12 - 45
made me chuckle!

Your self deprication with:
I'm afraid that I'm not going to be much help with a definite answer
and my totally unqualified opinion
puts things in perspective.

FD

[Whirlybird]

Flyin'Dutch,

Don't you think that's a little unfair? This is PPRuNe, not a medical website. Loose rivets made it quite clear that he wasn't medically qualified...as you emphasised in your quotes. There are a number of us here who find it quite useful to get various opinions, especially if the people giving them make it clear as to their qualifications or otherwise. This is especially the case, for me anyway, for something as vague and undefined as migraine...and I think that's even the case for the medical profession. PPRuNers are aware that they have to distinguish the knowledgeable from the haven't-a-clue opinions; that's normal on here.

[Flyin'Dutch']

Whirly,

Fair comment!

I appreciate that people visiting this forum as you say like to hear other folks' opinions.

However LR's post contained that many inaccuracies with regards to migraines and the treatment thereof that I felt compelled to emphasize this.

Maybe the modus was not very gentle, I concede.

It is difficult however to stand by and let people dissiminate blatantly incorrect information which others, despite the warning in the header of this forum then go on and propagate as gospel.

If you imagine being at a party, standing in a group and someone proclaims that helicopters are a very difficult and dangerous mode of transport. You would probably have something to say about that too, I imagine!

I have sent you a PM too.

Best regards

FD

[Loose rivets]

I have to say, that in the past I have taken the trouble to point out that it is unqualified opinion in the first statement...so okay, this is the case; but my source data is based on some serious papers. I simply do not have time to present this as a professional paper with all the references. I'm sure you know that it takes hours of work to turn a few pages of notes into a presentable publication. I would then have to ask for it to be vetted by a family member that is the only one qualified to publish such work. This I could do if someone was in desperate need of empirical data: this is not the case here.

If you would like to take issue about the specifics, I will try to explain why I have come to some of the conclusions that I posted.

If you can be amused by any aspect of Migraine, I can only suggest that you have never seen someone that you care about in the full throws.

When I stated that anyone can start migraine at any age, I was a little suspicious that the episodes that start in later life, are in some way different; and as I said in May, are not usually as bad. But they are very definitely diagnosed as Migraine by some specialists, who have regular patients fearing eye problems - these people go to have their eyes examined because they have no concept of the symptoms of Migraine. I was concerned about having made a mistake and called another eye surgeon for confirmation within the last few days. "A continuous trail of people..." (that disproves the belief that it can not start in later life.)

My concern is for pilots who have devoted their lives (and their fortunes ) to their career, and find that they may have something that will end it forever. I am only able to gather information and relay it; albeit with taking considerable care about the source material and 40 years of flying to give me some idea of how badly this problem could affect aircrew.

I have absolutely no right to suggest that anyone that has ever had - even just one - confirmed attack should fly. All I am saying is that it is a desperate shame to loose a career when the odds are not much different to any other person. Regular (confirmed ) attacks during teens and early twenties, are as I said, a logical and legal bar to holding any licence.

[hm671]

Sorry for taking so long to check back.

LOOSE RIVETS - well unbeknown to me until yesterday, I apparently also have "classic" migraine on my record as well as abdominal, and was informed by GP it was definetly a correct diagnosis as I was seen by one of the so called "experts" in this rather ambiguous field. However, I have definetly not had an attack of "classical" migraine for more than 4 years. Will this create an even greater problem in obtaining a Class 2 and possibly a Class 1?:confused:

[Loose rivets]

There is really not a lot that I can add. I say again that I am not qualified to make any real assessment. Perhaps it is worth mentioning that I do not have to be quite so guarded as a medical practitioner; and can bounce more ideas about...this is fine when it does not affect peoples lives as dramatically as this illness, but to counter this, I am open to all argument, and my only motive is to help pilots that may be faced with the sudden loss of their livelihood.

Sadly, some of those that disagree, seem reticent to substantiate or at least amplify their comments.

http://www.casa.gov.au/manuals/regulate/dame/080r0205.pdf

To recap, if someone suffers a period of substantial visual disturbance - seen as though it is in both eyes - and then this is followed by a moderate to severe headache and perhaps sickness, then there is a good chance that this is classical migraine. Another indicator is that the patient can feel perfectly well just before an episode.

Catching an episode while in a test environment is much harder than with epilepsy. The O2 consumption tomography is a valuable tool, but it is almost impossible to catch an episode because of the time-scales. I hope to find out more about EEG as a diagnostic tool, but again I suspect that it is just the problem of catching the episode. I would be interested to know if there has ever been a case of migraine / potential migraine, being diagnosed by EEG when patient is tested while feeling perfectly well.

I will be back in the US soon, and spending a lot of time in a university library that is devoted to neurological studies. If I can illicit the skilled help, I will try to post more specific and up to date information on diagnosis.

If there has never been any visual disturbance, I fail to see why a/ it would have been confirmed as migraine and b/ why there would be a probability of it suddenly reaching full classical status and disabling an operating aircrew sometime in the future...at least, any more chance than average.

For now, go over the posts; especially QDM's comments, and do a lot of soul-searching.

[Flyin'Dutch']

HM,

The only way you are going to find out whether you will be able to hold a medical is by applying for one to the authority in which country you seek to get a licence.

As I have said on here in the second post and LR illustrates in the link to the CASA, different Aviation Authorities take different views on whether individuals can be certified.

The diagnosis of migraines is made on the patient's history. There are no tests that can prove or dissuade that.

Unfortunately some people seem to be unable to understand that you can not validate every diagnosis with a test that comes with a printout.

Best of luck,

FD