migraine

[ewe.lander]

Friend of mine wants to rejoin British Military as Helicopter Pilot. Served for years, flew thousands of hours rotary with distinction, before leaving for career change.

Over 4 years ago he went through hell with his personal life resulting in headaches diagnosed as migraine. He has been clear of them for 4 years now and is very fit.

Question....will either the British Military medico's, or the CAA permit him to start flying for a living again?

[QDMQDMQDM]

Over 4 years ago he went through hell with his personal life resulting in headaches diagnosed as migraine.

Firstly, get the diagnosis reviewed. Many headaches diagnosed as 'migraine' simply aren't. True migraine is not that common, or at least not as common as people think.

QDM

[ewe.lander]

thanks for your steering fix QDM, assuming it is def. migraine, after 4 years clear what do you think the CAA or Military will say??

[QDMQDMQDM]

I don't know what their criteria are, but personally I would be surprised if a past history of definite classical migraine were an allowable condition for issue of a Class 1 or the military equivalent. It can cause rapid disablement with little warning and, knowing how sticky they are on other stuff, I'd be surprised if they let it through. I don't think I would if I were the powers that be.

That said, you'd better ask them. Or your friend had.

Personally, I would be interested to explore the possibility that these severe headaches were some kind of 'acute stress reaction', now resolved, and in fact were not migraine. Migraine can be an unhelpful label and, as I say, tends to be bandied about much too frequently both by the public and, shamefully, by some members of the medical profession. Go and see a neurologist.

QDM

[sneetch]

Hi people!

I don't mean to hi-jack this thread, but I too have a past history of classical migraine. My initial class 1 application was denied and have recently been told (after reapplying) that I must see a neurologist to "ascertain prognosis". I myself have not had a migraine in 12 years.

I now realise that I was never actually formally diagnosed with migraine but my experience does fit the clinical definition .......... although it was a very long time ago and it is becomming more and more difficult to remember.

Does anybody know exactly what a visit to a neurologist will entail?
I just wonder if it is really possible for a neurologist to suggest what might happen in the future in this situation.

[Circuit Basher]

During my early teens, I used to suffer a lot of headaches which would only be resolved by going and lying down in a dark room for a few hours. After many physiological tests, there was no resolved diagnosis, but the word 'migraine' was mentioned.

At an RAF initial medical for aircrew at the age of 16, discussions with the Gp Capt on the medical board (after I'd been failed for having slight myopia in one eye) suggested possible trigger foods. After a bit of experimentation, I identified chocolate as a key trigger. Eliminating chocalate from my diet reduced the frequency and severity of the headaches. I have now gone around 30 years without a full migraine, but do occasionally get a pre-cursor 'aura' of visual effects which usually consists of a progressive 'tunnelling' of the vision. If I take a prophylactic (such as paracetamol or preferably Migraleve) within an hour of these effects, it is not a problem and will abate within around 30 mins. I have not let it develop beyond this.

Triggers for me are typically stress, tiredness, excessive chocolate (more than about a Mars bar can be a problem, although white chocolate is OK) excessive caffeine :( and flashing lights (fluorescents with defective starters or strobes can be a reliable trigger).

I have a PPL and fly on a Class 2 JAR Medical. At initial test with AME, I declared the symptoms and frequency of my headaches and used the word migraine (despite never having had a formal diagnosis). CAA responded by saying that more that 3 events a month required review by a neurologist (I had put on my form an average of 3 a month). Due to a CAA admin booboo, they failed to review this. In the interim time (around 5 years), the frequency of my symptoms had reduced (since no longer being on the board of a company that was going into liquidation).

A year ago, I attended a medical for the RAF with a view to being a volunteer gliding instructor. I used the dreaded 'M' word and was told that this precluded a miltary medical aircrew grade. On appeal, I was advised to see a neurologist, which I did. After a discussion of my history / symptoms, he conducted a brief physical examination and a few tests of vision / neurological function (such as touching nose with eyes shut, etc). His diagnosis was one of classical migraine with aura. I have been refused a military medical as they inidcate that migraine and epilepsy are considered to be closely related. My only option is to get a Class 1 if the nice chaps / chappesses at the Belgrano were feeling benevolent!

I expect your friend is likely to be graded A3 (Unfit Solo) by the military.

[QDMQDMQDM]

Does anybody know exactly what a visit to a neurologist will entail?

They will take a thorough history and then examine you. If they think it's migraine there will likely be no further investigations. If there is some doubt, they might do further tests such as a brain scan of some sort. Private cost - about £150 for the consultation.

I just wonder if it is really possible for a neurologist to suggest what might happen in the future in this situation.

They can't. They have no crystal ball either. For you, though, I suspect the important question is: was this true migraine or not? I suspect -- but you'll obviously have to confirm with the CAA and / or military -- that a past history of classical migraine, irrespective of the time since last attack, will be disqualifying and if that is the case, I can well understand why that would be.

QDM

[Loose rivets]

As always, unqualified opinion.

Classical Migraine is logically an absolute bar to holding a pilot’s license. If it gets bad, the patchy blindness in the early stages can totally obscure large areas of vision. The ensuing headache can be utterly overwhelming – for hours. Following symptoms can include, projectile vomiting, loss of word meaning, memory generally, and numbness in fingers etc..

I am fairly sure that at no time is the aura experienced in one eye only, and that this in its own right, is one test for true classical migraine as opposed to some other defect.

There is no doubt that some people will experience a true episode only once or twice in their lives, as mentioned, during times of great distress etc. and it certainly seems a shame that an entire career is ruined because of a very unlikely reoccurrence.

Periods of deep nagging worry are more likely to be a cause rather than day to day stress.

The belief ( of some experts ) that Migraine will not start in the over 50’s is a fallacy. Eye surgeons have patients suffering their first episodes, late in life, on a regular basis. Though these attacks are rarely very severe.

There is a high probability that chocolate is a trigger, though it might need the stress (worry) factor to coincide, thus blurring the statistical analysis.

To sum up. If you get just a couple of mild attacks up to adulthood, and haven’t had anything for years, you are in with a good chance. (But there is still no certainty that the CAA will accept this.) If there have been numerous occurrences, with a definite rhythm, there is no way that you can spend the rest of your working life wondering if you will suddenly be disabled at the controls.

Your call, but it’s a tough one.