migraine medication and soaring

[Barbara de Zoete]

Recent medical check reveiled I suffer from migraine. Well, no harm done
there, since I seem to have that all of my life and am pretty much used to
it.

Still, after a long talk with my family doctor I do want to try and find
out if any medication helps me to either kill an attack or prevent an
attack occuring (preferrably). But... I would *never* want to take
medication that makes soaring impossible.

Anyone in here familiar with migraines or medication in relation to the
ability to fly?

TIA,

Barbara

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[cfinn]

The AOPA maintains a good medical section. If you go to:
http://www.aopa.org/members/databases/medical/search_faa_meds.cfm, and
check the waiver, you can enter a drug and see if it is OK with the
FAA. I looked at drugs used for Migraine treatment. There were 9
listed. Use was not allowed for 4. Of the other 5, 3 said to wait 24
hours after use. The other 2 showed no adverse effects.

I'd suggest you take a list like this and discuss it with your doctor.

Charlie

[Barbara de Zoete]

On 7 May 2005 06:32:02 -0700, cfinn > wrote:

> The AOPA maintains a good medical section. If you go to:
> http://www.aopa.org/members/databases/medical/search_faa_meds.cfm, and
> check the waiver, you can enter a drug and see if it is OK with the
> FAA.

That's a nice suggestion...

if you're an FAA member, that is :-)

I'm not, you see. I soar in Europe, in the Netherlands, but haven't found
any information the sites of our association or club and such.

Any other suggestions, anyone?


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[chipsoars]

I'd talk to your doctor about warnings (like don't operate machinery)
and see how you tolerate the medication.

I've used Imitrex for example, and still felt odd a day later. We are
talking about drugs affecting a neurotransmitter pathway; serotonin.
Older medications, lysergic acid derivitives (yest that is what Dr.
Hoffman at Sandoz was working on) have even more lingering side
effects.

I am not a doctor, but a medicinal chemist. Bottom line, get an expert
opinion and be conservative. It is better to miss a day's flying than
end up injured or worse.

Chip F.

[Barbara de Zoete]

[ Gee, doesn't anybody in here quote or attribute quotes or both? Funny
and difficult way of keeping a usenet discussion going... ]

On 7 May 2005 07:10:02 -0700, chipsoars >
wrote:

> I'd talk to your doctor about warnings (like don't operate machinery)
> and see how you tolerate the medication.
>

I intend to do that of course.

> I've used Imitrex for example, and still felt odd a day later. We are
> talking about drugs affecting a neurotransmitter pathway; serotonin.
>

My doctor therefore advised me a drug that is originally intended for
heart problems (Dutch: beta blokker). And in anyway, there are days I
can't fly without any drugs also :-)

> Bottom line, get an expert
> opinion and be conservative. It is better to miss a day's flying than
> end up injured or worse.
>

Oh, but I agree with that, of course. I think that when one is not fully
healthy one knows better how to be conservative, than anyone else. Just
thought I might get some experts opinion in here too, because experience
makes excellent experts IMO.


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[chipsoars]

Barbara,

some of these threads get to long to not cut out the proceeding
threads. I used beta blockers for a time with no effect. Around RAS,
you will find lot's of opinions, sometimes based on fact.

You might hunt around on FAA.gov or the EU equivalent for medications.
In the US, a medical is required for power ratings and I do know some
medications are disqualifying. I would expect that with the
international harmonization programs, most medical issues will be
handled similarly.

With gliders,no medical exam is required- it is supposedly an honor
system; if you have a health issue, you should not fly.

[Vaughn]

"Barbara de Zoete" > wrote in message
news:opsqenjua5x5vgts@zoete_b...
> Recent medical check reveiled I suffer from migraine. Well, no harm done
> there, since I seem to have that all of my life and am pretty much used to
> it.
>
> Still, after a long talk with my family doctor I do want to try and find out
> if any medication helps me to either kill an attack or prevent an attack
> occuring (preferrably). But... I would *never* want to take medication that
> makes soaring impossible.

For a significant percentage of migraine patients, there is a drug-free
solution. Migraine is often cause by the involuntary clenching of your teeth,
especially in your sleep. There is an FDA-approved device that is nothing more
than a hunk of plastic that reduces or solves the problem.
http://www.headacheprevention.com/ It also prevents damage to your teeth from
clenching/grinding.

Vaughn

[Barbara de Zoete]

On 7 May 2005 08:42:42 -0700, chipsoars >
wrote:

> some of these threads get to long to not cut out the proceeding
> threads.

I'm not saying to keep all of the thread. Just what you reply to. You snip
the rest. That is custom in large parts of usenet. Isn't it in here too?
This way:
1. people entering a thread here actually know what the post is about;
2. if archived this message serves a purpose beyond our discussion of this
one moment.

> I used beta blockers for a time with no effect. Around RAS,

What is RAS?

> you will find lot's of opinions, sometimes based on fact.


> You might hunt around on FAA.gov or the EU equivalent for medications.

Tried the Dutch association. No luck. Tried FAA, but am not a member, so
no access.

> In the US, a medical is required for power ratings and I do know some
> medications are disqualifying. I would expect that with the
> international harmonization programs, most medical issues will be
> handled similarly.
>

In the EU a medical is needed for soaring as well. The check is not as
thourough and strict as the one for power ratings, but it is a medical all
the same.
I could always ignore the new knowledge and live on happely ever after.
Lived with migrain, withou knowing that, for about thirty years or more
now. Just thought, if it is possible to fight off the pain _and_ keep on
flying, well, I would give it a try.

> With gliders,no medical exam is required- it is supposedly an honor
> system; if you have a health issue, you should not fly.
>

Well, I suppose this is always true, no matter what rating or system.

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[Barbara de Zoete]

On Sat, 07 May 2005 18:24:39 GMT, Vaughn
> wrote:

> "Barbara de Zoete" > wrote in message
> news:opsqenjua5x5vgts@zoete_b...
>
>> Recent medical check reveiled I suffer from migraine. Well, no harm done
>> there, since I seem to have that all of my life and am pretty much used
>> to it.
>>
>> Still, after a long talk with my family doctor I do want to try and
>> find out if any medication helps me to either kill an attack or
>> prevent an attack occuring (preferrably). But... I would *never* want
>> to take medication that makes soaring impossible.
>
> For a significant percentage of migraine patients, there is a drug-free
> solution. Migraine is often cause by the involuntary clenching of your
> teeth, especially in your sleep. There is an FDA-approved

What is FDA?

> device that is nothing more than a hunk of plastic that reduces or
> solves the problem.
> http://www.headacheprevention.com/ It also prevents damage to your
> teeth from clenching/grinding.
>

Erm, thank you for you input. I'll ask my dentist about the condition of
my teeth. :-)


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[John Galloway]

Barbara,

At 19:00 07 May 2005, Vaughn wrote:
>
> For a significant percentage of migraine patients,
>there is a drug-free
>solution. Migraine is often cause by the involuntary
>clenching of your teeth,
>especially in your sleep. There is an FDA-approved
>device that is nothing more
>than a hunk of plastic that reduces or solves the problem.
>
>http://www.headacheprevention.com/ It also prevents
>damage to your teeth from
>clenching/grinding.
>
>Vaughn
>


Actually this is a slight misunderstanding. Many recurrent
headache sufferers have in the past been diagnosed
as having migraine when they actually have jaw clenching
headaches. Also many migraine sufferers get other
kinds of headaches as well - including from jaw clenching.
The dental splints referred to by Vaughn are very
helpful for those people but they will not help true
migraine headaches.

I have a fair bit of experience of prescribing for
migraine

Of the migraine preventer medications the most appropriate
for a glider pilot would usually be the the original
beta blocker - propranolol. The use of propranolol
(or the similar drugs metoprolol, nadolol, and timolol)
for migraine prevention is actually making use of its
side effects because, unlike newer beta blockers, propranolol
is not very 'cardio-selective' in its effects and it
can get into the brain - where you want it to be.
Propranolol may not be suitable if your are asthmatic
(and possibly if you are diabetic). It can cause some
physical fatigue but not usually significant drowsiness.
It can cause cold fingers and toes and slows the heart
rate a bit but most people tolerate it pretty well
in my experience. It may also have interactions if
you are on other medications.

Personally, I would have no qualms about flying on
propranolol once I had tried it on the ground for a
while. It would need to be taken regularly to have
a chance to prevent migraine and it is available in
one a day long acting formulations (in the UK as 'Inderal
LA' (160mg) and 'Half Inderal LA' (80mg))

All the other usual migraine preventer drugs would
be more likely to be sedative.

To treat a migraine in the air in a single seater glider
would be difficult. The very effective and expensive
5HT1 agonists ('triptan') drugs (such as sumatriptan
(trade name Imigran)) are powerful medicine and you
would want to be very familiar with their use, side
effects, contraindications and interactions before
trying them. However, having once had completely unexpected
migraine with visual field effects flying XC solo in
the Scottish mountains I can say that the flight home
and prospect of trying to land in a field in that condition
wasn't much fun. So if I was a known migraine sufferer
and if I knew that triptans worked well and gave me
no bad side effects then I might consider carrying
some. In that case I might use the rapidly acting
soluble wafer formulation 'Maxalt Melt' or the nasal
inhalation variety of sumatriptan.

Powerful painkillers containing opiates, such as codeine,
are widely used (but best avoided) for treating migraine
attacks. They are sedative and likely to cause chronic
daily headache syndrome if over-used. It is now known
that migraine is not just caused by blood vessel spasm
alone and a non-infective inflammation of the meninges
can develop during an attack. For this reason there
is good logic in using an anti-inflammatory painkiller.
In the cockpit a simple and cheap way of doing this
would be to suck one or two 300mg soluble aspirin tablets.
(They don't taste too bad and I give one like that
to patients at home with heart attacks while waiting
for the ambulance)

If you get nausea and vomiting badly with your migraines
then that would be very difficult to treat safely and
effectively while flying solo as all the treatments
would be sedative to some extent. Also getting medication
to stay down long enough to work is a problem. The
best I can think of would be to use 'Buccastem' which
is a buccally absorbed preparation of the common anti
sickness and dizziness drug prochlorperazine. The
tablet is placed between the upper lip and the gum
and allowed to dissolve slowly (not sucked). The drug
is supposed to be absorbed directly into the blood
stream through the mucosa (skin) of the gum.

Prevention would be better.

All the usual warnings about discussing with your doctor
and checking with applicable authorities apply.

John Galloway

[chipsoars]

Barbara,

I don't do usenet other than this group so if there are protocols, I'll
have to plead ignorance.

FAA.gov doesn't require a membership. It is the US Federal Government
and anyone can access the site.

Chip

[Malcolm Austin]

Barbara,
RAS = rec.aviation.soaring (i.e. this newsgroup)

:-)

"Barbara de Zoete" > wrote in message
news:opsqe75icwx5vgts@zoete_b...
> On 7 May 2005 08:42:42 -0700, chipsoars >
> wrote:
>
>> some of these threads get to long to not cut out the proceeding
>> threads.
>
> I'm not saying to keep all of the thread. Just what you reply to. You snip
> the rest. That is custom in large parts of usenet. Isn't it in here too?
> This way:
> 1. people entering a thread here actually know what the post is about;
> 2. if archived this message serves a purpose beyond our discussion of this
> one moment.
>
>> I used beta blockers for a time with no effect. Around RAS,
>
> What is RAS?
>
>> you will find lot's of opinions, sometimes based on fact.
>
>
>> You might hunt around on FAA.gov or the EU equivalent for medications.
>
> Tried the Dutch association. No luck. Tried FAA, but am not a member, so
> no access.
>
>> In the US, a medical is required for power ratings and I do know some
>> medications are disqualifying. I would expect that with the
>> international harmonization programs, most medical issues will be
>> handled similarly.
>>
>
> In the EU a medical is needed for soaring as well. The check is not as
> thourough and strict as the one for power ratings, but it is a medical all
> the same.
> I could always ignore the new knowledge and live on happely ever after.
> Lived with migrain, withou knowing that, for about thirty years or more
> now. Just thought, if it is possible to fight off the pain _and_ keep on
> flying, well, I would give it a try.
>
>> With gliders,no medical exam is required- it is supposedly an honor
>> system; if you have a health issue, you should not fly.
>>
>
> Well, I suppose this is always true, no matter what rating or system.
>
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> `-------------------------------------------------- --<--@ ------------'

[cernauta]

John Galloway > wrote:


>I have a fair bit of experience of prescribing for
>migraine
>
>Of the migraine preventer medications the most appropriate
>for a glider pilot would usually be the the original
>beta blocker - propranolol....
(snip)

Now this was a great post! thank you very much

Aldo Cernezzi

[John Scott]

You might look at this web site and contact them. I know several of them
are gliders pilots and instructors, as well as doctors.

http://www.aviationmedicine.com/

John Scott

[Barbara de Zoete]

On 7 May 2005 21:30:49 GMT, John Galloway
> wrote:

> I have a fair bit of experience of prescribing for
> migraine
>
> Of the migraine preventer medications the most appropriate
> for a glider pilot would usually be the the original
> beta blocker - propranolol.

[snipped, but read thoroughly]

> All the usual warnings about discussing with your doctor
> and checking with applicable authorities apply.
>

This was informative and helpful. Thank you for your time and work on
this. I appreciate it very much.


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[[email protected]]

Barbara,

I am coming into this thread a bit late, but here it is: I asked my
wife (who suffers from occasional migraines) how does her IMITREX
affect her ability to drive. Answer: not at all. Still, as many of my
predecessors on this posting have indicated, it would be worthwhile to
investigate with your own flying authorities.

Cheers, Charles

[Mike Lindsay]

In article >,
Vaughn > writes
>
>"Barbara de Zoete" > wrote in message
>news:opsqenjua5x5vgts@zoete_b...
>> Recent medical check reveiled I suffer from migraine. Well, no harm done
>> there, since I seem to have that all of my life and am pretty much used to
>> it.
>>
>> Still, after a long talk with my family doctor I do want to try and find out
>> if any medication helps me to either kill an attack or prevent an attack
>> occuring (preferrably). But... I would *never* want to take medication that
>> makes soaring impossible.
>
> For a significant percentage of migraine patients, there is a drug-free
>solution. Migraine is often cause by the involuntary clenching of your teeth,
>especially in your sleep. There is an FDA-approved device that is nothing more
>than a hunk of plastic that reduces or solves the problem.
>http://www.headacheprevention.com/ It also prevents damage to your teeth from
>clenching/grinding.
>
>Vaughn
>
>
And the NTI website tells me there are two people providing them in
Holland...
--
Mike Lindsay

[Barbara de Zoete]

On Sat, 07 May 2005 22:21:58 GMT, Malcolm Austin
> wrote:

> Barbara,
> RAS = rec.aviation.soaring (i.e. this newsgroup)
>
> :-)
>

Should / could have thought of that... :-)
Thanks

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[CV]

chipsoars wrote:

> Barbara,
>
> some of these threads get to long to not cut out the proceeding
> threads.

Hmmm, interesting phenomenon ...

CV

[Bullwinkle]

All,

I'm an aerospace medicine physician who works full time with FAA medical
certification issues, for professional pilots (as well as flying gliders for
fun).

There was an excellent summary of treatment options earlier in this thread,
so I won't re-hash that.

Here's the FAA rules on this, were you applying for a medical. (Obviously we
don't need medicals in the US, but these are still good common sense
guidelines).

Prophylactic (preventive) meds, like betablockers (Inderal, tenormin), or
calcium channel blockers, or ACE inhibitors: Ok with the FAA if they work
for you, and you have no side effects which would prevent safe performance
of aircrew duties.

Abortants (like the triptans, including imitrex, maxalt, etc): No fly within
24 hours after last dose.

These rules apply to pain-only migraines which occur twice a month or less
freuently. If you get neurological symptoms, and particularly if you have
visual symptoms, the FAA usually requires a 6 month headache free interval
before clearing a pilot who requires a medical.

An earlier poster was correct, the VFS web site at www.aviationmedicine.com
is an excellent resource for these types of questions.

Hope this helps,
Bullwinkle

On 5/9/05 4:48 AM, in article opsqh8bly1x5vgts@zoete_b, "Barbara de Zoete"
> wrote:

> On Sat, 07 May 2005 22:21:58 GMT, Malcolm Austin
> > wrote:
>
>> Barbara,
>> RAS = rec.aviation.soaring (i.e. this newsgroup)
>>
>> :-)
>>
>
> Should / could have thought of that... :-)
> Thanks