Migraines
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Migraine with Aura
Anyone had any experience of revalidation of class one following migraine with aura. Any information would be much appreciated.
Probably worth a search, as this was discussed on here aproximately a year ago. I
think the thread linked to quite a good article in one of the aviation medical journals regarding medicals.
think the thread linked to quite a good article in one of the aviation medical journals regarding medicals.
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migraine with aura . . . . . . .
Look here:
www.gauci.info/gone2fly/JARS/JAR-FCL3-AMC-IEM.pdf
This is the JAR FCL-3 medical manual. It runs to 340 pages, but
the paragraphs you'll be most interested in are on pages 151-152.
Don't get too optimistic, though. In the UK the CAA medical
department take a very cautious stance on disorders like this.
www.gauci.info/gone2fly/JARS/JAR-FCL3-AMC-IEM.pdf
This is the JAR FCL-3 medical manual. It runs to 340 pages, but
the paragraphs you'll be most interested in are on pages 151-152.
Don't get too optimistic, though. In the UK the CAA medical
department take a very cautious stance on disorders like this.
Psychophysiological entity
Classicle Migraine
Very quickly...last Saturday Mail, and article by Rebecca Camber
Sufferers being offered an operation to remove muscles in the head that trigger the attacks.
Firstly, Botox is used to test the result. Then, if there is a reduction in the attacks, they remove the Corrugator muscle.
"Many, but not all, are triggered by interaction of this muscle with nerves in the head."
I feel fairly comfortable about this logic. I'm still convinced that the migraine is caused by a hormone that relaxes something that has gone into spasm, and I have always focused on the blood vessels clamping cos of perceived danger...but there is no reason to suppose a similar process would not be working for other spasms.
Sufferers being offered an operation to remove muscles in the head that trigger the attacks.
Firstly, Botox is used to test the result. Then, if there is a reduction in the attacks, they remove the Corrugator muscle.
"Many, but not all, are triggered by interaction of this muscle with nerves in the head."
I feel fairly comfortable about this logic. I'm still convinced that the migraine is caused by a hormone that relaxes something that has gone into spasm, and I have always focused on the blood vessels clamping cos of perceived danger...but there is no reason to suppose a similar process would not be working for other spasms.
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Classical migraine . . . . . . . .
This is taken verbatim from the JAA Manual of Civil Aviation Medicine :
Aeromedical Status
Migraine cannot be treated in pilots with ergotamine and other drugs, because such medications are
Migraine cannot be treated in pilots with ergotamine and other drugs, because such medications are
unacceptable in aviation due to side effects. Known migraineurs should not be selected for professional
aircrew training due to the unpredictability and disabling nature of the condition, but those who present
aircrew training due to the unpredictability and disabling nature of the condition, but those who present
after qualification either through worsening of the condition or an in-flight incident should be neurologically
assessed and any causal factor addressed. If no other structural abnormality is found and the individual is
migraine free for 3 to 6 months, a return to flying may be approved with a multi-pilot (Class 1 ‘OML’)
limitation. A fit assessment for solo operations must be evaluated against the history and type of
operation. Some prophylactic treatments such as propranalol, may be acceptable with each case being
reviewed individually.
A similar assessment applies to Class 2.
The following must be considered:
• Frequency of headaches
• Degree of incapacitation caused by the headache.
• Drugs used to treat the headache.
Adverse factors for aeromedical certification include:
- Sudden significant neurological symptom such as loss of vision, weakness and incoordination with no
warning
- Failure or of prophylactic treatment with frequent attacks
- Requirement for intensive treatment
- Short prodrome that does not allow effective use of acute treatment before symptom onset.
assessed and any causal factor addressed. If no other structural abnormality is found and the individual is
migraine free for 3 to 6 months, a return to flying may be approved with a multi-pilot (Class 1 ‘OML’)
limitation. A fit assessment for solo operations must be evaluated against the history and type of
operation. Some prophylactic treatments such as propranalol, may be acceptable with each case being
reviewed individually.
A similar assessment applies to Class 2.
The following must be considered:
• Frequency of headaches
• Degree of incapacitation caused by the headache.
• Drugs used to treat the headache.
Adverse factors for aeromedical certification include:
- Sudden significant neurological symptom such as loss of vision, weakness and incoordination with no
warning
- Failure or of prophylactic treatment with frequent attacks
- Requirement for intensive treatment
- Short prodrome that does not allow effective use of acute treatment before symptom onset.
Hope that's helpful, at least as a starter.
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Migraine with aura
I am presently 'temporarily unfit' for my class1 due to migraine with aura. Age 47 18000 hrs ATPL and flying since age 16 so quite a shock.
My symptoms are;
Sudden smokey vision with fixed black/blind spots followed approx. 5mins+ later by an accute throbbing headache on the rightside and the feeling of reduced coordination of my rightside limbs.
I have been to consultant neurologist. He sent me for an MRI scan which i am glad to say showed no irregularities.
The next step is a trial of medication recommended by the neurologist, at present Half Inderal 80mg (beta blockers). I've been on these for 1 month and had one migraine. The next step is 160mg Inderal.
The C** medical advisers have been supportive but obviously non commital about which medications may be allowed ; "just get yourself sorted and then we will review your case" I really wanted to know which medications are allowed and start with those first!
The end of my of sick pay looms. (lucky to have sick pay these days I know!)
Any ideas folks?
My symptoms are;
Sudden smokey vision with fixed black/blind spots followed approx. 5mins+ later by an accute throbbing headache on the rightside and the feeling of reduced coordination of my rightside limbs.
I have been to consultant neurologist. He sent me for an MRI scan which i am glad to say showed no irregularities.
The next step is a trial of medication recommended by the neurologist, at present Half Inderal 80mg (beta blockers). I've been on these for 1 month and had one migraine. The next step is 160mg Inderal.
The C** medical advisers have been supportive but obviously non commital about which medications may be allowed ; "just get yourself sorted and then we will review your case" I really wanted to know which medications are allowed and start with those first!
The end of my of sick pay looms. (lucky to have sick pay these days I know!)
Any ideas folks?
Reassuring that the neuro specialist couldn't find anything major, but it dissapointing that your symptoms havn't resolved.
I'm not an AME, but from years of lurking around here, it seems the CAA will be more interested in your symptoms than your medication. (I suspect that they don't have a list of "banned" medications- rather they treat each case on it's merits). Trouble with propioception/co-ordination will worry them.
Inderal will probably help half to three-quarters of migraine sufferers, but of course, you have to take it every day, as a prophylaxis.
Keep on hanging in there, be patient, most patients with migraine can be helped.
Any obvious triggers to avoid ? (Tiredness, stress, chocolate, red wine, coffee, cheese,PMT??)
Keep us posted.
I'm not an AME, but from years of lurking around here, it seems the CAA will be more interested in your symptoms than your medication. (I suspect that they don't have a list of "banned" medications- rather they treat each case on it's merits). Trouble with propioception/co-ordination will worry them.
Inderal will probably help half to three-quarters of migraine sufferers, but of course, you have to take it every day, as a prophylaxis.
Keep on hanging in there, be patient, most patients with migraine can be helped.
Any obvious triggers to avoid ? (Tiredness, stress, chocolate, red wine, coffee, cheese,PMT??)
Keep us posted.
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unfortunately . . . . . . . . .
Inderal will probably help half to three-quarters of migraine sufferers
I suspect that they don't have a list of "banned" medications
(Inderal-LA and Half-Inderal-LA are brands of Propranolol). Almost all the other beta-blockers are deemed OK, especially for treating things like hypertension, but propranolol is considered to have almost psychotropic effects. Remember that it is frequently used as an anxiolytic.
Sorry if this isn't quite what you were hoping to hear.
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Thank you for your replies and help gingernut and AMEPPL.
If the prophylactic does not work, Topiramate is suggested as the next to try.
Then Almotriptan.
Any views on these?
Perhaps it maybe time to blow the dust off the A & C spanner tickets!
If the prophylactic does not work, Topiramate is suggested as the next to try.
Then Almotriptan.
Any views on these?
Perhaps it maybe time to blow the dust off the A & C spanner tickets!
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from bad to worse . . . . . . . . . .
Topiramate is suggested as the next to try . . . . . . . .then Almotriptan
my gut feeling is that neither of these two will be welcomed with open arms at the good old Belgrano !
Triptans as a group are 5-HT antagonists, which probably work quite well in many cases of migraine, but, as with so many things, have the potential for some degree of drowsiness or impairment of alertness, at the very least.
Topiramate is probably even worse, as its principal indication is as an anticonvulsant in major epilepsy. Its use as migraine prophylaxis is a secondary one, and not extensively trialled or tested. As you can probably imagine, even the mention of the word "epilepsy" within the hallowed portals of the Belgrano is likely to trigger what is little short of a tsunami !
Please explain what you mean by " A and C spanner tickets" ! !
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very probably . . . . . . . . .
Is Lyrica on the banned list?
Lyrica (pregabalin)
under the heading "what's it used for ?" migraine isn't even mentioned, but epilepsy and anxiety definitely are.
It would be well worth asking about this in your own country too (FAA).
We have seen examples on this forum in fairly recent weeks of other countries where very different approaches are taken to pilots on mind or mood altering medication. I can only advise that under the JAR system (which includes the UK CAA) such things are very firmly proscribed - and I personally hope it stays that way. Safety first at all times !
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Worth investigating the possibilty of a PFO (patent Foramen ovale) - there is an associated between these and severe classicle migraine. If found and closed they can make a big difference or even stop migraines. Migraine society are doing a trial on it.
We look at this closely in scuba divers as they have an increased risk of decompression illness
Ian
We look at this closely in scuba divers as they have an increased risk of decompression illness
Ian
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AMEandPPL Thanks for the info. wish I'd done a post earlier!
PFO? Flappy heart thingies? Help!
A & C 'licence' for aircraft engineering which I picked after my apprenticeship. Didn't stay around long enough to get proper B licences! Prob all changed in last twenty-odd years.
A is no good without a proper engineer (B) & C does the paperwork,
Blah Blah
PFO? Flappy heart thingies? Help!
A & C 'licence' for aircraft engineering which I picked after my apprenticeship. Didn't stay around long enough to get proper B licences! Prob all changed in last twenty-odd years.
A is no good without a proper engineer (B) & C does the paperwork,
Blah Blah
Last edited by Old Royces lad; 7th Jul 2008 at 21:22.
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Discover magazine....
I remember reading about some type of experimental treatment in discover magazine a couple of yrs ago..... Might be worth searching the website over there.
Anyhow-Someone came up with a special wand that a doctor simply passes over your scalp as soon as you feel the migrane start.... Supposedly, this "aura" you describe can precede the actual migrane by some amount of time in some people.
The neat thing about the device is that it emits a pretty strong magnetic field. The theory of why it works for some people is pretty interesting:
Apparently the "aura" is actually a very specific set of bneurologocal interactions happening in the brain which sort of "constructs" the very specific set of conditions needed for the migrane to happen. This device interrupts the electrical impulses needed for the mnigrane to take place.
According to the article, the set or "cascade" of interactions varies greatly from person to person, but apparently, the hope for this device is based on the fact that it seems to reliably interrupt this cascade of interactions. According to what they seem to know about migranes, if you can hit the "aura" part of the event enough times, the brain cannot produce migranes anymore because the "cascade" or chain reaction which occurs during the aura stops happening. Essentially, this device makes the brain forget how to construct a migrane.
-Painless, no drugs.
-Sorry I can't remember exactly what this thing is called, but it has to do with electromagnetic stimulation, and it looks an awful lot like a metal wand they use at a security checkpoint.
Anyhow-Someone came up with a special wand that a doctor simply passes over your scalp as soon as you feel the migrane start.... Supposedly, this "aura" you describe can precede the actual migrane by some amount of time in some people.
The neat thing about the device is that it emits a pretty strong magnetic field. The theory of why it works for some people is pretty interesting:
Apparently the "aura" is actually a very specific set of bneurologocal interactions happening in the brain which sort of "constructs" the very specific set of conditions needed for the migrane to happen. This device interrupts the electrical impulses needed for the mnigrane to take place.
According to the article, the set or "cascade" of interactions varies greatly from person to person, but apparently, the hope for this device is based on the fact that it seems to reliably interrupt this cascade of interactions. According to what they seem to know about migranes, if you can hit the "aura" part of the event enough times, the brain cannot produce migranes anymore because the "cascade" or chain reaction which occurs during the aura stops happening. Essentially, this device makes the brain forget how to construct a migrane.
-Painless, no drugs.
-Sorry I can't remember exactly what this thing is called, but it has to do with electromagnetic stimulation, and it looks an awful lot like a metal wand they use at a security checkpoint.
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TMS
I checked the Discover magazine website and it looks like they don't go back that far.
Anyhow, I did a search or two and found the name of the device.....
It is called TMS-stands for Transcranial Magnetic Stimulation. I think the FDA is still testing it. Anyhow-it involves no drugs and is harmless-not a magic sure, but it seem to really help a significant percentage of people who have tried it.
Anyhow, I did a search or two and found the name of the device.....
It is called TMS-stands for Transcranial Magnetic Stimulation. I think the FDA is still testing it. Anyhow-it involves no drugs and is harmless-not a magic sure, but it seem to really help a significant percentage of people who have tried it.
Psychophysiological entity
If I had to guess, the operation, if addressing the right type of migraine, would stop the process before it began.
I hope that they soon scotch this illness, because it can ruin the lives of anyone aflicted, pilot or not.
I hope that they soon scotch this illness, because it can ruin the lives of anyone aflicted, pilot or not.
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Many years before flying, I used to suffer from alot of heavy migraines.
Do you know what it was??
Would you believe - Red cheese & Fizzy Pop at school.
These foods had E numbers in them & the culprit was - E145.
So I have avoided E numbers ever since.
Now I don't get hardly any migraines.
My GP at the time said E numbers are a common factor of migraines.
Do you know what it was??
Would you believe - Red cheese & Fizzy Pop at school.
These foods had E numbers in them & the culprit was - E145.
So I have avoided E numbers ever since.
Now I don't get hardly any migraines.
My GP at the time said E numbers are a common factor of migraines.
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Headache/Migraine help?
I fly G reg on an FAA Pilot Certificate with a 3rd class medical. My last medical was a couple of years ago, next medical is not due for another 3 years.
I have recently started getting headaches every few weeks. There are no visual aura. I have been prescribed Zolmitripan by my GP, which seems to stop the headache after an hour or so. If I do not take the medication, then I'll sometimes start vomiting for a while before it gets better.
The whole experience feels exactly like the hangovers I used to get when younger.
The headaches develop over several hours, they are not sudden, so I would not be in a situation where it occurs without notice in the air.
I drink alcohol very sparingly, I have tried cutting out cheese and chocolate, and drinking more water but I don't think these are the triggers. For example, I had no headaches over Christmas!
Questions then.
1. Do I need to ground myself?
2. Do I go and see an AME. If so, what will he/she say?
3. Is this really migraine, or could it be just headache?
4. Any suggestions on isolating the cause?
I have recently started getting headaches every few weeks. There are no visual aura. I have been prescribed Zolmitripan by my GP, which seems to stop the headache after an hour or so. If I do not take the medication, then I'll sometimes start vomiting for a while before it gets better.
The whole experience feels exactly like the hangovers I used to get when younger.
The headaches develop over several hours, they are not sudden, so I would not be in a situation where it occurs without notice in the air.
I drink alcohol very sparingly, I have tried cutting out cheese and chocolate, and drinking more water but I don't think these are the triggers. For example, I had no headaches over Christmas!
Questions then.
1. Do I need to ground myself?
2. Do I go and see an AME. If so, what will he/she say?
3. Is this really migraine, or could it be just headache?
4. Any suggestions on isolating the cause?