Migrains

[P.O.M]

As these headaches are quite a common occurance I suspect they have already been discussed on here, but I have only just been diagnosed and would appreciate any help with a couple of questions:confused:

Is there anyone thats had restrictions put on their licence beacause of migrains?

I have been given two types of medication to treat them, both reactive rather than preventative, normal disprin and a nasal spray called Imigran.
Each spary is a single use disposable pack, containing the drug SUMATRIPTAN.
Anyone able to say if this would be troublesome for a pilot (side effect wise)

Anyone fly here that suffers these nasty headaches?

Cheers,
P.O.M:D

[Circuit Basher]

I have a childhood history of migraines (although they were never called that at the time - approx 35 years ago!). At 16, it was suggested that a possible trigger could be chocolate, so I virtually eliminated chocolate from my diet; the frequency / severity of the symptoms was alleviated significantly.

At the time of my CAA Class 3 Medical (6 years ago), some concerns were raised by CAA SRG 12 months after I had the medical and mutterings made about them checking with a neurologist. Nothing further was heard until about 5 years later, when they suddenly noticed (9 months after about the 2nd renewal of my by now JAR Class 2 Medical) that I'd aggregated about 170 hrs and a PPL. They have now written to me saying that I mustn't fly within 24 hrs of recovery after sensing the initial stages of a migraine or within 8 hrs of taking paracetamol (which is all I need). If I exerience any preliminary effects in flight, then I am to land at the nearest airfield.

As I was also under training with the RAFVR(T) as a gliding instructor, I declared my status to the RAF vets and they have waved their hands in horror at the 'M' word and said that I would only get a Cat A3 (Unfit Solo) unless a neurologist could confirm that I didn't have migraines. I have seen a neurologist and it cost me £240 to be told that I have migraines.

I can thus fly without limitation under my PPL (other than basic common sense precautions) but will never be allowed to fly an RAF glider solo.

I am unsure whether I am precluded from a JAR Class 1 or not.

Check out this thread for other discussion on migraines Thread Re: Class 1 Medical and Migraines (http://www.pprune.org/forums/showthread.php?s=&threadid=55501)

(PS Hope the link works, as I'm a PPRuNe virgin at linking threads!!! ;))

[P.O.M]

G'day CB

Thanks for the reply and yes the link worked, I'm just about to read thru it (good job for a virgin linker ;) )

Now I have had the MD diagnose migrains, I need to check with my Av Med to see what his thoughts are, I'm hoping it wont effect me with a commercial licence.

Thx Again
Cheers
P.O.M:D

[PilotsPal]

I've suffered from migraines for over 25 years and Imigran (either 50 or 100mg tablets) is what works best for me. I have never experienced any side effects with sumatriptan. Aspirin and paracetamol-based products are completely useless and don't touch the pain in the slightest. You don't say what type of migraine you have - common or classic (both equally painful). I've more or less outgrown the classic type (probably hormonally triggered in my case) and am stuck with the common type. Depending on bad the nausea and sickness is, you may need to get your GP to prescribe something to combat that.

How much warning of onset do you get? Learning to recognise the onset is the most valuable thing you can do - the sooner you can use the Imigran the less prolonged the attack will be.

A couple of small things that might be of assistance to you: I'm very sensitive to bright sunlight as a trigger so first class sunglasses are essential. Dehydration (even only slightly) is another possible one so if your normal daily water intake isn't very much, make sure you increase it. Sensitivity to certain food groups is worth exploring - the ones with the worst reputation are chocolate, cheese, coffee, red wine/port/brandy - try eliminating all of them and see if it helps.

[Bird Strike]

Citrus fruit and MSG can be triggers too. It's useful to chart your migraine (and possibly other headaches) and what you eat, do, etc., so that you can work out a pattern and possibly avoid trigger factors.

Increasing the vitamin B2 and Magnesium intake is supposed to reduce the frequency of migraine too.

[PAXboy]

Migraine is a very complex subject and highly individual to the sufferrer. For many, migraine passes with low level symptoms. Others are in bed for two or three days.

Essentially, they fall into two categories where the 'trigger' is an external substance (such as the well known chocco, cheese and red wine) or an 'internal' cause.

Also, migraine is often experienced in puberty. A friend of mine had this but has been free for many years and holds an ATPL. This is similar to epilepsy that emerges in puberty and then receeds by the late teens. Another friend of mine had this badly but has not had a fit in over 20 years. For myself, migraine only started in my early 30s but I must now have medication to hand at all time.

For some, avoiding the trigger substance is the main point with medication for the slip ups or when substances might be in meals prepared by others - such as air lines!!!

Onset is also individual. Many can sense this by what is called 'the aura', normally a disturbance to vision and often the appearance of 'dancing' spots of lights in the vision. Medication must then be taken. My ex-wife experienced some vision disturbance but the most marked was that her speech was disruppted. She would speak a sentance - but it would come out all mixed up. She could hear that it was mixed up and know what was happening. Truly frightening the first time it happened.

To give another example, my migraine is 'internal' and stress related. During a period of high work or stress, I am fine. Diamond. No problems. Keep going. Once that time is past - then I have a migraine! This is well known in men and is called a 'wind-down migraine' The most likely times for me to experience this are on a Saturday and during the first week of holiday.

Also, I get no warning, as the migraine wakes me up. Typically, at 06:00 on a Saturday morning. Since I normally sleep very late, there is no mistaking the sensations. I do not get 'aura' as I am asleep and awake with the migraine already fully established.

I become highly photo senstive and any light is unbearable. Hence I always have a set of sleep shades to hand. My set from VS Upper Class are the best!

A couple of times a year, I can get a migraine onset during the day but this is rarer - however, it happened last Tuesday evening! (it has been a VERY stressfull week).

I used to take over-the-counter Migralieve and still carry this for minor attacks. A friend suggested that I ask my doctor for 'Maxalt Melt'. This dissolves on the tongue and so is more rapidly absorbed into the bloodstream. For those that experience nausea this is also helpful. The active ingriedient is 'Rizatriptan'. This family, called 'The Triptans' are new and very effective. I can take a maximum of two in 24 hours. For severe attacks, I have Mobic Meloxicam that dilates the blood vessels in the brain to help ease the blood flow. Both of these are prescription only but my doctor is fab and allows me repeats as required.

Side effects - of the condition, we have mentioned vision and other disturbances and nausea is a problem for many. I have experienced it occasionally, particularly in the early days before diagnosis. Following my change to Rizatriptan - never.

Side effects of the medication - are extreme drowsiness. Preferably sleep! Again, this is personal, if I wake with migraine, I can expect to be in bed for the next 5 to 9 hours, depending on severity of the attack. With OTC medication it was 12 to 15 hours.

I suggest you contact and join a UK charity Migraine Trust. (www.migrainetrust.org/) As Bird Strike suggests, keep a migraine diary for a while, noting symptoms and your activities immediately preceeding an attack. For myself, I gave them 'ratings' a Class 1 was low and I could keep going, just not doing things like driving or other visually intensive activities up to a Class 5 that meant I was out for the day and experienced the worst symptoms of the attack,

If this has been rather too much information, I apologise but as I said - it is a very complex subject and much research is being done. Here is a quote from the above site:
Migraine is a complex condition with a wide variety of symptoms which show that various metabolic, neurophysiological and biochemical changes take place during an attack. For many, the main feature is the headache but for children the headache may be milder, and it is the gastrointestinal symptoms like stomach ache which tend to be predominant. It is also a disorder which comes and goes, with complete freedom between attacks.

[P.O.M]

Thanks to those who have posted their thoughts & experiences.

After talking to my Doc, and seeing what has been posted I can understand now alot of what I have been experiencing.

The 'wind down' migrain as indicated by PAXboy is a common one for me, usually after a long hands on flight (for those unfamiliar with Western Australia navigating here in remote areas is fairly intense for the inexperienced du to lack of Nav Aids:( ), or after a hard/stressful week again like PAXboy usually the first day of the weekend!!:mad:

I can also 'sense' when a migrain is coming on, as opposed to a 'normal' headache so I hope to be able to kill it then with the medication perscribed.

My Doc also suggested making a migrain diary to see if there is a trigger other than (i know this sounds really wierd) stress relief.:confused:

my primary concern is about the drug and how - if at all - it may effect me, but I guess I'll have to wait untill I need to use it in anger ;)

Cheers
P.O.M :D

[PAXboy]

Glad to be of assistance P.O.M. Although I rarely have daytime onset, I have learnt when I am 'vulnerable' to migraine, as I term it. This is why, on Friday night before turning in, I made sure that all my drugs and the eye shade were by the bed!! In the end I did not need them.

In eight days it will be different as the project I am working on will have completed ... :(

I have not yet been to Oz but your comment on navigating the western desert reminds me of my father's experience in North Africa. If I may digress?

In the early part of the war, my father and his pilot had to deliver some new Beaufighters to Cairo. This meant picking them up from Bristol's factory at Filton and taking it for a fuel test flight over the Irish Sea. Then, to quote from my father's book, "Our route out would start at Portreath on the North Cornish coast and then via Gibraltar; French North Africa; Libya (recently liberated by the 8th Army!); Cyreniaca and on to Cairo. We would probably be going in company with four or five other Beaus - although not in formation."

Once over the desert, they had the problem of navigating ... "Our route lay via Touggart and Gaadames to Castel Benito. The trip took us 4.55 hrs. but there is no mention in my Log Book of the struggle I had with the sheaf of maps I had picked up at Gib and my efforts to distinguish a 'second class camel track' from a 'first class camel track' as we cruised at 8,000 ft. over the Sahara Desert ... I should mention, for the uninitiated, that a first class camel track was shown on our maps with two dotted lines, whereas the other had only one dotted line. They looked fine on the map, but when I looked down from my cupola in the back of the Beau, I saw neither tracks nor camels!"

So I can understand why deserts give you migraine!

[Bird Strike]

P.O.M.

You need to check with a DAME that you are permitted to fly (and if not, how long you have to leave it before flying) after taking Imigran, even if you do not notice the any effect. But I'd have thought that not flying for at least 24 hours is sensible, not just because of Imigran but because of why you had to take it.

FYI, CASA's policy on migraine is to assess each case individually, according to their aviation medical manual.

[P.O.M]

Bird Strike:- I will be in the near future going to see my DAME to see what the migrains will, if anything, do with regards to holding my PPL. I haven't in the past nor will I in the future fly within a couple of days of having an 'attack', and definately not after medication till I have confirmed with a DAME.
My attacks don't normally come on strong enough to incapacitate me, however I don't want to be flying when one decides its going to be the first....my last one was probably the worst I have had, hence me going to see my GP.

PAXboy:- Flying in the outback is probably the closest I could get to imagining what it was like 70 odd years ago before things like Nav Aids were around to help, easier now with the advent of affordable GPS, but your bolloxed if the batteries die!:p
If you get down this way give us a hoi!

Cheers,
P.O.M:D

[PAXboy]

That's kind of you P.O.M. I am trying to plan a trip to Oz and NZ but my nephew is getting hitched in South Africa this December, so it'll be that part of the Southern Hemisphere instead!

Incidentally, about 18 months ago, returning from CPT on a daylight to LHR with VS, I looked out of the window and telephoned my father. He was expecting me that day and the line quality was so good, he did not realise where I was!!

So when he asked me how tired I was, I said that it was fine as I had my feet up (Premium Economy), had a drink and, by the way, we had just crossed the North African coast .....

He laughed so much and I told him how I had just visited the flight deck and told the crew about his Class 1 Camel Tracks!

I don't recall what the cost of the phone call was but it was worth every penney. He died about eight months later and I treasure that phone call. :) :) :)