Headaches and Medical Certification for Pilots
I recently encountered a new applicant who had suffered from classic migraines for years, and never sought or been offered evaluation and treatment for his problem. This posed an opportunity for care as well as a challenge for medical certification.
When completing your 8500-8 form at the time of your medical, you mark a box yes or no pertaining to the question of “Frequent or severe headaches”. Headaches are a diverse set of problems. While they most commonly are caused by muscle tightness, sometimes aggravated by underlying degenerative arthritis or emotional tension, some headaches can be signs of more ominous diseases, including those that could cause “sudden incapacitation”.
Migraine often includes headache, but may occur in the absence of any head pain. Typically, this disorder begins with an “aura”, or warning symptom that may include change in vision. The headache of migraine is usually described as a throbbing, one sided, and often is associated with increased sensitivity to light or sound, as well as the presence of nausea. Migraine sometimes can be associated with transient neurological symptoms, including numbness and weakness that behave like a “temporary stroke”- things we would rather not encounter at 8,000 feet!
Fortunately, Migraine and other types of headache can be treated with options that are allowable to the FAA. We are however limited from some medications we might choose if pilot medical certification were not an option.
If you, as a pilot, do have headaches on a frequent basis, it will be necessary to clarify this issue during your medical exam. You should list on your the frequency, duration, characteristics, severity of symptoms, any neurologic manifestations, and whether the headaches have ever been incapacitating. If treatment is used, this should be described and whether any side effects have occurred.
To paraphrase the neurological standards for medical certification, there must not be a history of seizures or epilepsy, a prior disturbance of consciousness or loss of nervous system function without satisfactory explanation, or which may be likely to make the pilot unable to safely perform the duties or privileges to be held.
Simple headaches without sequelae are not disqualifying. Longstanding headaches, if mild, not incapacitating, and not associated with neurological problems should not hold up your certification. Of course, you are obligated to self disqualify when headaches are likely to occur or require treatment. Other headaches, including migraine or cluster headaches, will require special evaluation and consideration by the FAA. Chronic tension or post-traumatic headaches also will require an FAA decision.
If you do have significant headaches, any supporting information you can provide from your regular provider will expedite the issuance process. Wherever possible, if the certificate cannot be issued immediately, I try to clarify barriers to certification before a pilot leaves the office. Remember, with persistence, most medical conditions that require initial deferral are subsequently issued FAA medical certificates.
It is our job as AMEs to advocate for you as a pilot, and most of us take pride in helping to keep you flying!
Steve Wahls is a Senior Aviation Medical Examiner and Family Physician who practices at OHSU Family Medicine in Scappoose. He holds a private pilot certificate and is available for aviation medical consultation or pilot medical exams.
April 1, 2011