Migraines and imitrex

[Unregistered]

What does the FAA say?

Get headaches couple times a year. Imitrex for acute symptoms. Haven't actually had to fil the prescription for a few years.

 

[AggieMike88]

From: http://aviationmedicine.com/medications/index.cfm?fuseaction=medicationDetail&medicationID=26

Medication Class — Migraine Headache Medications

Medication Class Description:

Individual cases vary greatly. However, after evaluation and FAA review, the agency will permit use of certain prophylactic migraine headache medications. These medications to prevent migraines, beta blockers and calcium channel blockers are primarily used for heart conditions and high blood pressure, but may also be effective in vascular (migraine type) headaches. FAA approval requires documentation that the medication is successful in preventing the occurrence of headaches. See the AMAS article on Headaches for a complete discussion.

In April of 2013 the FAA modified their policies to allow the Aviation Medical Examiner (AME) to clear the medical for migraine and chronic headaches such as classic or common migraine, tension headaches, or cluster headaches (not ocular migraine or complicated migraine) as long as they occur no more than monthly, there are no in-patient hospitalizations and not more than two exacerbations in the last year for this condition, there cannot be TIA type symptoms, vertigo, or mental status changes, the provider documents the condition is stable, and the AME warns of no flying for 24 hours after triptan use, 36 hours after reglan use, or 96 hours after phenergan use. Injectable or narcotic medications are not allowed.



Medications Within Class:

Sansert, Imitrex, Zomig, caffergot

 

[Unregistered]

What do I need to line up ahead of time to make this a non issue?

 

[AggieMike88]

1. Speak with your AME in a consultative session (aka off the record) and ask.

2. Search these forums for past answers from Dr. Bruce about migraines

3. Contact Dr. Bruce directly by email. The link in his signature usually works. If it doesn't, you can find the address @ www.aeromedicaldoc.com

 

[bbchien]

If you have never had an ocular phenomenon assoc. with the headache, see if you qualify for this.....see attachment.....if not, it's a special issuance, neurologist's eval and detailed medical description, MRI in addition to the attachment....

 

[Palmpilot]

If you have never had an ocular phenomenon assoc. with the headache, see if you qualify for this.....see attachment.....if not, it's a special issuance, neurologist's eval and detailed medical description, MRI in addition to the attachment....

And to (hopefully) clarify, if I understand it correctly, an "aura," which is perceived equally in both eyes, is not an ocular phenomenon.

 

[bbchien]

No. The visual aura creates the demand for an SI. At that point the question is can the pilot see through the aura, and it has to be followed as they can morph quite nicely into something incompatible with flight.

Seen in both eyes, it's from the visual occipital cortex and is very closely related to epilepsy.

 

[Unregistered]

Different poster now than the OP

I read the .pdf attachment and have a question. The form states that an Ocular migraine and complicated migraine are not acceptable. (assumes this means that an SI is required) How does the FAA define an Ocular migraine. Is it just the presence of the aura that triggers this or does it follow the definitions of a retinal migraine (as defined from WebMD www.webmd.com/migraines-headaches/guide/ocular-migraine-basics) (I'm sure there is a better source somewhere but it's what I have access to right now)

I ask because I have dealt with the random migraine for 20 years now. From age 16 to 29 I would get them about once a year. They would start with the Aura for about an hour and then proceed to a full migraine but the aura would leave. Once I reached my 30's they stopped and I went about 7 years without a migraine, but I have had two within the past 2 years, again at a frequency of one a year. The onl medication I have ever taken is OTC Ibuprofin and Exceedrin Migraine.

Is it possible to get a 3rd class without an SI? If I need an SI then think I will forget the SEL rating and just go for Sport Pilot. I currently only have a Private Pilot Glider rating and luckilly no medical is required.

 

[Unregistered]

Also of note I did not have the Aura during the most recent two migraines.

 

[JeffDG]

In April of 2013 the FAA modified their policies to allow the Aviation Medical Examiner (AME) to clear the medical for migraine and chronic headaches such as classic or common migraine, tension headaches, or cluster headaches (not ocular migraine or complicated migraine) as long as they occur no more than monthly, there are no in-patient hospitalizations and not more than two exacerbations in the last year for this condition, there cannot be TIA type symptoms, vertigo, or mental status changes, the provider documents the condition is stable, and the AME warns of no flying for 24 hours after triptan use, 36 hours after reglan use, or 96 hours after phenergan use. Injectable or narcotic medications are not allowed.

That sounds an awful lot like the "Letter of Eligibility" I got in 2008 or 2009 for cluster headache. Basically, you're good-to-go, but no flying within 24 hours of Imitrex use (which I've not used since 2005).

 

[JeffDG]

Dr. Bruce, curriosity:

[ ] OTC headache medications; warn airman:
24 hour no-fly - Triptans
36 hour no-fly - Metoclopramide (Reglan);
96 hour no-fly - promethazine (Phenergan)
NOT acceptable: Injectable medications and narcotics

For the "NOT acceptable: Injectable", does that mean that if you take something like sumitriptan, that you have to do the oral or nasal spray, not the self-injector? I know a lot of people with cluster really like the injector because of how fast it works and the fact that cluster headaches tend to be of much shorter duration than classical migraine.

 

[bbchien]

Different poster now than the OP

I read the .pdf attachment and have a question. The form states that an Ocular migraine and complicated migraine are not acceptable. (assumes this means that an SI is required) How does the FAA define an Ocular migraine. Is it just the presence of the aura that triggers this or does it follow the definitions of a retinal migraine (as defined from WebMD www.webmd.com/migraines-headaches/guide/ocular-migraine-basics) (I'm sure there is a better source somewhere but it's what I have access to right now)

I ask because I have dealt with the random migraine for 20 years now. From age 16 to 29 I would get them about once a year. They would start with the Aura for about an hour and then proceed to a full migraine but the aura would leave. Once I reached my 30's they stopped and I went about 7 years without a migraine, but I have had two within the past 2 years, again at a frequency of one a year. The onl medication I have ever taken is OTC Ibuprofin and Exceedrin Migraine.

Is it possible to get a 3rd class without an SI? If I need an SI then think I will forget the SEL rating and just go for Sport Pilot. I currently only have a Private Pilot Glider rating and luckilly no medical is required.

If there is any visual phenomena during the aura or the migraine itself, it's defined a visual migraine.

For the "NOT acceptable: Injectable", does that mean that if you take something like sumitriptan, that you have to do the oral or nasal spray, not the self-injector? I know a lot of people with cluster really like the injector because of how fast it works and the fact that cluster headaches tend to be of much shorter duration than classical migraine.

If you inject sumitriptan into a vein, accidently, you might not be able to be PIC due to the vascular spasm that ensues....in the brain.....in the heart.....well I think you get it. That "could be bad...."

 

[JeffDG]

If you inject sumitriptan into a vein, accidently, you might not be able to be PIC due to the vascular spasm that ensues....in the brain.....in the heart.....well I think you get it. That "could be bad...."

Yabutt...the Journal of Obscure Herbal and Homeopathic Medicine said it was fine...

(Sorry, Dr. B...just yanking your chain!)

OK, I can see how a direct injection of a vasculoconstrictor into a vein could cause...issues. I guess there's a reason I never went beyond the nasal spray for myself...