Headache (including migraine)

Guidance for medical examiners when assessing a patient for either a general topic or condition – Headache (including Migraine).

Aeromedical implications

Effect of aviation on condition

  • Fatigue
  • Operational stresses

Effect of condition on aviation

  • Overt incapacitation
    • rapid onset without warning
    • neurological deficits
    • pain
    • vomiting
  • Subtle incapacitation
    • aura
    • neurological deficit
  • Distraction due to treatment and symptoms.

Effect of treatment on aviation

  • Side-effects including sedation

Approach to medical certification

Based on the condition: any of the following

  • Photophobia and/or photopsia
  • Phonophobia
  • Dysphasia
  • Other sensory features
  • Other motor features
  • Disabling pain
  • Vomiting
  • Rate of onset less than 30 mins

Based on treatment

  • Manage effectively with preventative treatment
  • Absence of side-effects

Demonstrated stability

  • Absence of symptoms for 3 months AND
  •  Stabilised on any preventative medication for that period 

Risk assessment protocol - information required

Initial and follow-up applications require you to complete the following form:

Indicative outcomes

  • In combination with a rapid onset, incapacitating or distracting symptoms represent a serious safety risk
  • A period of grounding to demonstrate freedom from severe headaches and the acceptability of any medication will be required
  • Neurological reports will usually be required for commercial pilots, and for private pilots on a case-by-case basis
  • Multi-crew restrictions and passenger-carrying restrictions or other restrictions may be imposed


  • Demonstrated absence of severe headaches for a minimum of 3 months
  • Acceptable preventative medication eg calcium-channel blockers, beta-blockers, aspirin, AT2 inhibitors if free from side-effects. (NB Beta-blockers carry aerobatic restriction)
  • Known and avoidable triggers and sufficient warning of impending episodes


  • Frequent severe headaches and / or neurological symptoms, even if pain-free
  • Preventative medication such as tricyclics, ergot derivatives and anticonvulsants
  • Severe headaches with other accompanying symptoms

Pilot and controller information

  • Any recurrence must be reported to the DAME
  • Any change of medication must be reported to the DAME
  • Multi-crew restrictions and passenger-carrying restrictions or other restrictions may be imposed


We value your feedback.


The clinical practice guidelines is provided by way of guidance only and subject to the clinical practice guidelines disclaimer.

Last updated:
Online version available at: https://www.casa.gov.au//licences-and-certificates/medical-professionals/dames-clinical-practice-guidelines/headache-including-migraine
Back to top of page