Ocular migraines - What's the threshold for the FAA to want a neuro exam?

[Anonymous]

I get occasional ocular migraines, about 1-2 years between episodes. This was previously reported to the FAA, and they felt it was infrequent enough to not ask for any additional documentation.

Recently they seem to have gotten more frequent. About 2-3 times per year.

Episodes always follow the same pattern: Some mild blurriness that makes reading a little more difficult (but still doable) about 15 minutes before the migraine, followed by an aura in my peripheral vision that lasts for about 15-30 minutes, followed by a very mild headache that will last for a couple hours. If I take a couple Ibuprofen + Acetaminophen at first onset, it aborts the headache.

Does anybody know how the FAA's going to view this on my next third-class renewal? With episodes occurring >1 year, they didn't seem to care. However, I suspect episodes <1 year apart will at least pique their interest.

Notably, I've never been to a neurologist. I'm wondering at what point it's worth spending the time to get it fully examined and documented by a specialist. (I'm assuming they're not going to do anything to treat it given the frequency and low severity.)

Compared to others who have migraines, I should consider myself lucky - it's all pretty mild. But of course any visual disturbance is concerning, and I'm aware the FAA is picky about this one.

 

[Rushie]

When young I had a very few, like just 2 or 3 in a decade, FAA yawned if I recall. I can’t answer your question about what they’ll say about your increased frequency, but just opine that yes I think it’s worth seeing a neurologist. But that’s just me; I like to investigate anything that has to do with vision thoroughly. The first time it happened I had never heard of aura and thought I was going blind, went to the eye doctor in a panic.

I haven’t had one now for many years, decades maybe, knock on wood. Good luck, there are a couple AMEs here that will give you the FAA scoop. I wish you the best.

 

[Lowflynjack]

I used to have these a few times a year, but never thought they would prevent me from flying safely. I never had one in flight. From the research I did, they don't know what causes them, don't know how to stop them, they seem to occur mostly in men. Essentially, I was told to cut back caffeine. I did and I haven't had one since.

 

[Bell206]

Recently they seem to have gotten more frequent. About 2-3 times per year.

FYI: if you wear glasses and possibly changed prescriptions or went to bifocals and especially progressive bifocals this could be the cause for more frequent ocular episodes. It was for me when I went to progressives. The light refracting through the variable lens is what triggers mine on a more frequent basis.

 

[Eldorado]

I see no advantage going thru a lot of tests by a neurologist. You have a diagnosis that seems very accurate according to your symptoms. Very little has changed thru the years. If you come up with new symptoms that you’ve never had before, I’d change my advice.

 

[Lindberg]

Look up the symptoms for Classic Migraines. Occular Migraines are a very specific thing, and not all Migraines with visual symptoms like you describe are Occular Migraines. Classic Migraines are a condition your AME can issue for without FAA input as long as you have no more than one per month and meet the other criteria. If you say you have Ocular Migraines you'll likely get deferred.

https://www.faa.gov/about/office_or...me/guide/app_process/exam_tech/item46/amd/ha/



https://www.faa.gov/about/office_or...ffices/aam/ame/guide/media/C-CACIMigraine.pdf

 

[bbchien]

Ocular migraines are siblings to epilepsy. If you’re talking 3rd class, you will need to see the neurologist, AND the ophthalmologist, both.....

 

[Rushie]

You learn something new every day. I didn’t know ocular and classic migraines were two different things.

https://theyenews.com/ocular-migraine-vs-visual-migraine/

TLDR:

classic: both eyes affected by flashing and/or loss of part or all of the visual field

ocular: one eye has visual loss due to decreased blood flow to the retina, a more serious condition

 

[Lindberg]

You learn something new every day. I didn’t know ocular and classic migraines were two different things.

https://theyenews.com/ocular-migraine-vs-visual-migraine/

TLDR:

classic: both eyes affected by flashing and/or loss of part or all of the visual field
[AME CAN ISSUE IN OFFICE]

ocular: one eye has visual loss due to decreased blood flow to the retina, a more serious condition
[REQUIRES DEFERRAL, NEURO WORKUP, FAA APPROVAL]

Do not tell the AME "Ocular Migraine" when you mean "Migraine with Aura."

 

[Eldorado]

? Ocular migraines are siblings to epilepsy? Do not see any relationship between reduced blood flow in the retina lasting 15-60 minutes and epilepsy which involves abnormal electrical activity in the CNS. Patient has a long history of migraines with visual aura. Nothing he has stated would make me question this diagnosis. Other than trying to determine if any foods(wine, chocolate, etc), meds, or triggering mechanism might be involved, I’d state no changes from previous exams.

 

[libertas]

I used to get migraine with aura when I was younger, and had to rectify the medical history with the FAA. Your symptoms sound very similar to what I experienced, minus the preceding blurry vision. For me, I supplement my diet with magnesium. Give it a shot, it's cheap and safe if you are reasonable with dosage. I'd try that for a while before you go to a doctor and put it on your record. I haven't had them in a long time, and never since I started flying.

 

[bbchien]

? Ocular migraines are siblings to epilepsy? Do not see any relationship between reduced blood flow in the retina lasting 15-60 minutes and epilepsy which involves abnormal electrical activity in the CNS. Patient has a long history of migraines with visual aura. Nothing he has stated would make me question this diagnosis. Other than trying to determine if any foods(wine, chocolate, etc), meds, or triggering mechanism might be involved, I’d state no changes from previous exams.

"If I disagree it must be fake". sigh.

 

[Rushie]

? Ocular migraines are siblings to epilepsy? Do not see any relationship between reduced blood flow in the retina lasting 15-60 minutes and epilepsy which involves abnormal electrical activity in the CNS. Patient has a long history of migraines with visual aura. Nothing he has stated would make me question this diagnosis. Other than trying to determine if any foods(wine, chocolate, etc), meds, or triggering mechanism might be involved, I’d state no changes from previous exams.

"If I disagree it must be fake". sigh.

How to trigger Rush to go down a rabbit hole to find out the true answer.

Conclusion: Yes, there is most definitely an association between migraines and epilepsy and apparently a bigger concern with ocular migraine although I couldn’t find any research papers that differentiates ocular from other forms of migraine with respect to epilepsy comorbidity. (But in my defense I only spent an hour or so looking.)

However the NHS in the UK finds that epilepsy is one condition that raises your risk of ocular migraine. The FAA throws “complicated migraine” in with ocular as the no-go kind. These include forms that severely incapacitate such as half your body being paralyzed during an attack.

The biggest problem I see is semantics. Does the OP really have ocular migraine? Better to rename it “monocular migraine” or “retinal migraine”.

In my opinion it is folly to go looking for a common mechanism tying seizure to vasoconstriction of the retinal artery (unless you are an actual medical researcher) but I could believe electrical malfunction of any part of the brain including the occipital cortex could be related to arterial misbehavior elsewhere around the brain/optic system without knowing exactly how this happens.

Maybe there’s no mechanism. It might be nothing more than genes that travel together. But the FAA has concluded that retinal migraine carries greater risk of other incapacitating events including epilepsy (stroke is another by the way) than does classic migraine and the FAA probably spent more than my hour figuring it out, so I have to give this one to Bruce.