Migraines and headaches

Considerations

Migraines are relatively common. It is estimated that 18% of women and 6% of men have had at least one migraine attack in the previous year.

Nearly everyone would have experienced headaches. A rare episode of mild headache without any impairing symptoms can generally be regarded as being of no aeromedical significance. The same applies to rare episodes of more severe headaches that are clearly related to temporary benign illnesses.

The diagnosis of migraine is based on history. Often the history taken by the first doctor after the initial episode(s) is useful. Hence GP, ED or after hours care clinic medical notes are useful in confirming the diagnosis and identifying the severity and triggers for migrainous episodes.

Headaches and migraines are of aeromedical significance if capable of distraction or interfering with the visual, sensory and motor functions, affecting the ability to concentrate because of pain, nausea, vomiting, photophobia, and impaired motor function. Rapid speed of onset, unexpected onset, long episode duration of few hours or longer, need for strong analgesia, and disruption/cessation of activities due to migraine are also features of aeromedical significance.

The potential adverse consequences of a given migrainous episode during flight are likely to be different depending on the type of operation. For instance, a single pilot operating by night under IFR may be unable to cope with a relatively mild migrainous episode. However, the same pilot suffering from a similar episode might be able to land safely if flying under VFR by day. Thus, operational restrictions may at times provide adequate mitigating circumstances.

Information to be provided

• A headache investigation report: This questionnaire should be completed in all cases presenting with a history of migraines, or recurrent headaches, and in cases presenting with any episode of moderate or severe headache in recent years;
• Copy of the GP notes for the past 2 – 5 years (depending on the case), unless the ME is confident about the reported history;
• A neurologist report if there is uncertainty regarding the diagnosis or the headache characteristics.

Disposition

A history of headaches / migraines should be assessed as being of aeromedical significance unless:

• There is absence of nausea, vomiting, photophobia, phonophobia, aura, sensorial or motor features; and
• There is an avoidable triggering cause;
• There is no need to take medication other than Paracetamol or a NSAID;
• There is no need to attend for acute medical treatment; and
• There is no inability to carry on with a task when suffering from an episode of headache / migraine; and
• The headaches / migraines are infrequent, occurring less than twice per year; or
• The headaches / migraines have not occurred in the past 5 years; or
• The headache / migraine was a single event related to a temporary benign illness.

Through the flexibility process many cases of migraines / headaches have a favourable outcome. For instance:

A Class 2 applicant with migraines that are predictable and infrequent, have auras of slow onset, do not interfere with function, and are not accompanied by severe headaches, vomiting or neurological impairment, is likely to obtain a medical certificate following the flexibility process, perhaps with operational restrictions.

A Class 1 applicant is less likely to be issued a certificate. However a young applicant, with a similar history of mild migraines / headaches, who has been free of symptoms for over two years, is more likely to obtain a medical certificate following the flexibility process. Operational restrictions may apply.