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

Favourable

  • 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

Unfavourable

  • 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

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Disclaimer

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
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