Headache/Migraine info

[Guest jzurn1]

My question is simple. I know that having migraines disqualifies you for a pilot position, but I also read that if you have not had a migraine in over a year you can be considered for a waiver. Is this true and have any of you heard of someone receiving a waiver although they have had migraines in the past? If anyone has any info about migraines and waivers or knows anyone how has info about migraines and waivers please let me know. Thanks for your help!

[Guest Flight Doc]

The minimum period of time from last migraine to waiver is quoted as one year. Historically, only about half the persons who are *already trained* who apply for a waiver for migraine are approved.

I've never seen a waiver for migraine for FC I or FC IA, not to say it's impossible.

For initial waivers for migraine, it's a lot more probable to get an FC III waiver as, say, a flight medical technician than a FC I to become a pilot.

[Guest mlekenoyer]

How about getting a waiver for Migraines to be a Flight Engineer? Is it still the 1 year waiting period? Does the Guard have the same restrictions as active duty?

[Guest Flight Doc]

ANG, AFRC, and AD AF standards are the same. That said, sometimes things do vary. Migraine requires waiver for any flying job and they all require the one year minimum to be considered for waiver.

They are more likely to support a migraine waiver for nonrated aircrew (e.g., FE or load) than a pilot, but the waiver is still needed and not all that easy to get.

For migraines, the most likely to be approved for waiver is from an avoidable cause. The classic example is migraines in females at the "wrong time of the month" that can be prevented by oral contraceptives.

[ 14 March 2003, 20:06: Message edited by: Flight Doc ]

[Chicken]

My wife went to a neurologist, per her flight doc, for headaches she would get on occasion. She was diagnosed with migraines which now has made her DNIF. She did not have a CAT scan. Is this stilla valid diagnosis without one? Is there anyway to go back on that diagnosis and say "nevermind"? Can a 2nd opinion overturn it?

I have read that she can start to fly a year after her last migraine. Is this true? Who's to say we don't just say her last migraine was in March of 2003? She will be starting on various hormone type "therapy" I guess.. She has said the headaches can sometimes be bad, but not to the point she would want to give up her job. If she does have to stay DNIF for one year is it simply a matter of saying that the headaches are gone, or is there some sort of test to see if they are really gone?

Also, what can a worse case scenario be? She cannot be medically discharged from the AF can she??

[Flare]

Eeewwwwww.... migraines and headaches are bad juju... is she in pilot training right now or already rated or what? That could potentially make a difference on how much they're willing to work with her. I don't know how much difference it would make, but I would definately seek a second opinion.. F16PilotMD can tell you if that would make a difference or not. While I am in no way claiming to be any type of doctor, I do have about 7 years of pharmacy experience and I did see several people getting prescriptions for migraines, only to find out later that it was caused by something else rather than just having a migraine. My point is that we saw doctors who were quick to jump to that conclusion (whether right or wrong) and her doctor MIGHT have done the same. Again, I stress that that's just my opinion. I do have a friend that went through pilot training here....he got a headache after his first trip through the centrifuge and he was DNIF for almost 2 years...a very long time, but he was finally able to get all of the paperwork straight and got back in and got his wings. So hope is definately not lost.

I'll let the doc take those other questions you had...way above my pay grade.

[Guest F16PilotMD]

This is a problem from a flying standpoint. It may also be a problem staying in the USAF although that is less likely. Headaches, as outlined below, are DQ. The waiver is entertained only after one year symptom free (see waiver guide below). The waiver history for migraines is not good...~50%. Headaches will DQ you from ANY military service if they interfere with job performance.

No, there is no way to "undo" this. Second opinions are always good but your diagnosis comes from a neurologist...there is no other specialist to see. I suppose you could see a second neurologist if they will entertain that idea (?).

The common sense approach that I take to this very, very common complaint is to rule out other systems that cause headache. It is typically sinus or eye related. I have also seen "stress" cause recurrent, severe headaches. Notice, I did NOT say migraine. That is a very specific diagnosis, much different from severe headaches. These diagnoses are often over-used and mis-used by physicians who don't understand the ramifications (ENJJPT, you are right on about that).

I would say at this point your only hope to avoid at least a year DNIF is to make certain other headache-causing problems are not the culprit. Any neurologist worth their weight should do this...but ???????? Your Flight Doc should be able to help make sure of this.

----------------

AFI48-123

A7.23.1.4. History of any of the following types of headaches:

A7.23.1.4.1. Recurrent headaches of the vascular, migraine, or cluster (Horton’s cephalgia or

histamine headache) type.

A7.23.1.4.2. A single incapacitating headache of any type (e.g.,loss of consciousness, aphasia,

ataxia, vertigo or mental confusion).

A7.23.1.4.3. Headache of any type which are of sufficient severity to likely interfere with flying

duties.

A7.23.1.4.4. Acephalgic migraines.

NOTE: *A waiver for migraines may be considered following one year of symptom free observation.

Migrainous strokes and migraines complicated by neurological deficits other than transient visual

changes are not waiverable.

------------------------------

AFPAM-48-132 (Waiver Guide)

Updated-3/99

By LtCol. Kinne

CONDITION: MIGRAINE

I. Overview. The epidemiology of migraine headache has become clearer due to a number of large scale population-based studies using standardized case definitions (see below). The estimated prevalence of this disorder in the general adult population is approximately 6% for men and 18% for women. Prevalence is highest between 25-55 years of age. The condition most frequently begins in adolescence. Migraine is not a homogeneous disorder as attacks may vary in intensity, duration, frequency of occurrence, and in associated features. This variability may occur from one migraine sufferer to another, or even in one migraine sufferer from one headache to the next. Migraine sufferers may also describe headache patterns consistent with more than one headache type (e.g. tension-type headaches and migraine headaches). Note that some experts view migraine and tension-type headaches as distinct diseases while others view them merely as ends of a continuum of severity. In the end, the diagnosis in both clinical practice and epidemiological research is almost entirely dependent on the patient’s description of prior attacks (i.e. symptom profile). In occupations where a diagnosis of migraine could threaten a career (such as military aviation), there may well be attempts to avoid the reporting of such headache conditions.

Features characteristic of migraine include unilateral location (although generalized headache occurs in up to 30-40% of patients, and both acephalgic and ophthalmic migraines also occur), severe pulsating quality (although there may be a range starting from dull, deep and steady pain), an onset that tends to be gradual over minutes to hours, and a duration which may last from hours to days. Onset is common upon awakening in the morning and in the late afternoon, but may occur at any time during the day or night. Associated features include nausea (87%), vomiting (56%), photophobia (82%), phonophobia, visual disturbances (36%), lightheadedness (72%), vertigo (33%), and alterations in consciousness (18%). Precipitating factors include stress (often during post-stress “let down”), fatigue, physical exertion, glare, hunger, certain foods and/or medications, atmospheric changes (e.g. weather, altitude, and ambient temperature), fluorescent lighting and chronobiologic challenges (e.g. alterations in sleep/wake cycles, jet lag, changing seasons, etc.). Migraine may also be precipitated by menstruation (presumably due to hormonal changes).

Standard migraine therapy can be divided into prophylactic, abortive, and therapeutic. Prophylactic pharmaco-therapy includes the use of beta-blockers, NSAID’s, calcium antagonists, SSRI’s (selective serotonin reuptake inhibitors) and other antidepressant medications, certain anti-seizure drugs, and ergotamine preparations. The first-line of prevention, however is the avoidance of known or suspected triggers, especially foods which may precipitate migraines in individual patients. Alternative therapies such as relaxation or meditation techniques, cervical manipulation, acupuncture, etc. have also been advocated. Abortive pharmacotherapy includes the use of sumatriptan or DHE. (Intranasal lidocaine has also been used but is reported to have only transient effect.) Treatment for an established headache includes sumatriptan, DHE, antiemetics (e.g. compazine or phenergan), narcotics and sedatives. None of the aforementioned pharmacologic therapies are, themselves, waiverable for flying.

II. Aeromedical Concerns. The pain of a migraine headache may disrupt concentration at best and be totally incapacitating at worst. Associated features such as visual disturbance, vomiting, or vertigo could themselves be incapacitating during flight. Concern would be greatest for those flying single seat aircraft, or in aircraft where complete crew participation and coordination is essential for mission completion. However, significant concern exists for any aircrew member in any type of aircraft. Additional concern exists because of the potential duration of the headaches and the consequent fact that the flyer would need to be grounded until complete resolution occurs (potentially days). Lastly, concern exists for the patients personal well-being because, if not controlled, a severe migraine attack could result in a neurologic event such as a ischemic stroke.

III. Information Required for Waiver Submission. A complete evaluation with neurological consultation is indicated. Ophthalmological consultation is also indicated in the event of associated visual disturbance. New onset migraine-type headaches, a change in previous migraine character, or occurrence of complicated migraine are all likely to necessitate brain imaging (typically a CT scan or MRI). There is little reason for angiography unless a cerebral aneurysm is suspected. EEG’s are of questionable value since there are no specific abnormalities peculiar to migraine headaches.

IV. Waiver Considerations. Since 1977, a total of 82 FC II/IIA evaluations for migraine headaches were accomplished. Eventual waiver was given in 57% of the cases with the other 43% eventually being disqualified from flying duties because of the condition. During that same period, 98 FC III migraine evaluations were accomplished, 41% receiving waivers and 59% being disqualified.

Initial waiver for migraine is usually not granted, although a documented symptom-free period of twelve months has been used in the past to eventually obtain a waiver. Cases of complicated migraine, such as those having a loss of consciousness or significant associated neurological deficit other than a partial visual field loss, result in automatic disqualification with little chance for waiver at any time in the future. Any aircrew with a history of transient visual disturbance with or without headache should be initially disqualified. If a precipitating cause for migraine can be identified and avoided and the patient remains symptom free for at least one year, then a flying class II or III waiver can be considered.

[ 25. March 2004, 09:50: Message edited by: F16PilotMD ]

[Chicken]

Thanks for the help and info..

My other question is, even though she has been diagnosed by a neurologist as having migraines, can she start flying earlier if they determine it to be something else? (i.e. something found hormonally or whatever in her blood work they just did). Or, is she screwed from flying for at least a year+ now??

[Guest F16PilotMD]

If they find her headaches attributable to another cause, then they should change her DNIF status based upon that new diagnosis.

[Guest dumaisj]

Chicken, just curious....but something you may want to pursue. Does your wife eat or drink a lot of things containing aspartame? It's unbelievable how many conditions have been linked to this supposedly "safe" additive. Migraines is one of the most common symptoms. Aspartame poisoning recently caused my Graves' Disease, which also supposedly has no cure. I am in residence here in TX at the US Olymoic Training Center for diving, where we have a nutritionist on staff. She mentioned it to me, which I though was INCREDIBLY interesting. I have since stopped consuming ANYTHING that contains aspartame. "Miraculously," I am euthyroid now WITHOUT medication 30 days later. Doesn't happen, you say? There is a prominent AME In Brownwood, TX, Dr. Hays, who has been speaking out on its dangers, especially for flight crews, for years. I would check it out. I am now in the process of attempting to change my diagnosis so that the Graves' is merely an effect of the aspartame. We'll see if I'll still require a waiver for my IFC1. Good luck, I'd be happy to answer any ?s you might have. It's an interesting subject of which I have just become aware, but I'm glad it did before I left to compete at the Games in Athens. I have felt better that I ever have now! It's incredible! You also might check out this link for more info: www.sweetpoison.com . I hope your wife can benefit as much as I did! Keep me posted.

[Chicken]

I believe I have seen that in some of the things we have printed out.. what types of things is this in? She uses Sweet N Low and other non sugar sweeteners daily in her coffee, as well as other drinks like crystal light, etc. Is that along the same lines?

[Flare]

I'm not totally sure about Sweet N Low, but I think that it's the same as Equal & NutraSweet, which is aspertane.

[Guest dumaisj]

Sweet n Low is merely saccharin, which has lost a great deal of popularity due to its aftertaste. NutraSweet was the brand name for aspartame until its patent ran out. Aspartame is now produced generically by nearly everyone. It is the ingredient in Equal. It's also in approximately 5000+ products, particularly diet soda, most protein powders and bars, so-called "lite" and "sugar-free" foods, and sugar-free gum. Your doctor is unlikely to acknowledge any connection between the aspartame and the migraines. The medical community, for the most part, has ignored the "anecdotal" evidence regarding aspartame. I would urge you to delve into that website I posted earlier. It will answer several of your questions, but feel free to shoot more my way. Your wife should most definitely stop adding the artificial sweeteners to her coffee. As I said, I was completely cured of my Graves', something with no medically-recognized "cure." (I seem to be using several quotation marks, but they are appropriate in this case) It is very possible that your wife will experience a similar recovery once she stops ingesting the aspartame. Research it further; it'll blow you away. I'm going to post a long explanation under all the discussion topics to help get the word out. If it only helps one fellow aviator, I'm glad I did it. It will explain several aspects of the aspartame poisoning in more detail, as well as list several AF and major airline pilot experiences with the additive. It is nasty stuff. I hope this aids your wife!

[Guest F16PilotMD]

I wouldn't bet the farm on this "cure". Good advice is, "everything in moderation". Chances are, the toxins in your tap water are more dangerous than your diet soda. Fifty diet sodas a day, well, okay, maybe you're on to something. If you look on the web long enough you will find a homeopathic cure for anything. If they don't hurt you, give it a shot. Cutting NutraSweet out of your diet won't hurt you so.......

But, if the headaches go away, don't expect your flight doc to buy off on this cure and return her to flying status.

[Guest dumaisj]

Generally, I would concur; it is always wise to approach something of this manner with a skeptical eye. I also agree that the flight doc is unlikely to recognize it as "aspartame poisoning." It just hasn't been recognized as an issue by the FDA. However, you'd be surprised by the body of evidence supporting the toxicity of the additive as it is quite shocking. Were you aware that 80% of all the yearly additive complaints filed with the FDA concerned aspartame? Also, I've personally spoken with several AMEs who have had numerous cases of just such a diagnosis. They certainly will not brush it off as merely anecdotal. I do agree that eliminating aspartame for one's diet is NOT a cure-all panacea, but from the details Chicken posted, it seemed his wife was in perfect health otherwise ANd consuming quite a bit of the additive. I do not discount that every case of Graves' Disease will not respond to such a measure, but as I did not fit the typical patient profile at all (middle-aged woman with a family history), I chose to investigate before accepting a doctor's diagnosis wholeheartedly. I merely suggest that his wife try it. It is a very inexpensive way that may eliminate her migraines. There may be a valid underlying condition, but she can at least test it. If she does indeed experience relief, she can verify the fact by resuming the aspartame consumption to see if symptoms return. My suggestion was merely a esy, costless measure that may indeed remedy her migraines. Even if the flight doc will not change his diagnosis, she will, at least, be migraine-free and certainly in a much better position to fight for her flying status. One last addition: check into Dr. HJ Roberts' view on aspartame. His is not only a critically acclaimed MD and certainly one of the Who's Who of the medical community, but also one of aspartame's most vehement opponents. He has testified several times before Senate hearings on the saety of the additive. It is certainly worthwhile reading. I am definitely open to further discussion. Thanks!

[Guest JoeMama]

Along the same lines of Aspartame, please be careful eating bread. Here are some alarming "facts" about bread:

1. More than 98 percent of convicted felons are bread users.

2. Fully HALF of all children who grow up in bread-consuming households score below average on standardized tests.

3. In the 18th century, when virtually all bread was baked in the home, the average life expectancy was less than 50 years; infant mortality rates were unacceptably high; many women died in childbirth; and diseases such as typhoid, yellow fever, and influenza ravaged whole nations.

4. More than 90 percent of violent crimes are committed within 24 hours of eating bread.

5. Bread has been proven to be addictive. Subjects deprived of bread and given only water to eat begged for bread after as little as two days.

6. Bread is often a "gateway" food item, leading the user to "harder" items such as butter, jelly, peanut butter, and even cold cuts.

7. Bread has been proven to absorb water. Since the human body is more than 90 percent water, it follows that eating bread could lead to your body being taken over by this absorptive food product, turning you into a soggy, gooey bread-pudding person.

8. Newborn babies can choke on bread.

9. Bread is baked at temperatures as high as 400 degrees Fahrenheit! That kind of heat can kill an adult in less than one minute.

10. Most American bread eaters are utterly unable to distinguish between significant scientific fact and meaningless statistical babbling.

Back to aspartame and Dr. Roberts:

<<check into Dr. HJ Roberts' view on aspartame.

His is not only a critically acclaimed MD and

certainly one of the Who's Who of the medical

community, but also one of aspartame's most

vehement opponents.>>

Other than the anecdotal "evidence" surrounding Dr. Roberts' crusade against aspartame, where are the studies? If he is a "critically acclaimed MD" then he knows (or should know) that anecdotal evidence +/- expert opinion are not the strongest scientific evidence to support his position.

Let's see a nice standard randomized double blind placebo controlled study to back up his assertions. If he's so strongly convinced of the dangers of aspartame, I'd imagine he would be quick to start such a study.

If the study supports his views, the medical community (including flight surgeons) would find it much more difficult to dismiss them.

[Guest dumaisj]

Actually, before mocking, I suggest you do indeed look for yourself. The reason there have been no such studies is because aspartame is a toxic load that will affect everyone differently. In essence, to draw on the chain adage, you wind up becoming as strong as your weakest link. As everyone's genetic weak link will vary, so shall the resulting symptoms. It's rather difficult to design an all-encompassing study. Also, it might be just a bit difficult to scrounge up funding for studies to dispute such a cash cow as aspartame. Then Gov. Bush neither signed nor vetoed a bill here in Texas that criminalized verbal attacks on non-perishable food items, effectively allowing it to become law. Not big business in action, you say? AS I STATED ABOVE QUITE CLEARLY, eliminating aspartame for you diet is a cheap, safe, and quick way to rule out a possibility. It, in itself, is not a complete answer to the world's maladies. Oh, btw....you forgot one in your list. Bread makes you fat, and evidently, unusually susceptible to inane ranting and raving.

[Guest JoeMama]

<<Actually, before mocking, I suggest you do indeed look for yourself.>>

I had a little time earlier, so I looked through the literature. One interesting study I found was a 1995 randomized, double-blind, placebo-controlled, cross-over study done in New York and published in "Epilepsia." They took 18 individuals who had said that their seizures were provoked by aspartame and monitored their EEGs continuously for 5 days while giving Aspartame 50mg/kg or placebo in divided doses at 0800, 1000, 1200 on study days 2 and 4. Meals were standardized, yadda yadda yadda.

Results suggested that aspartame "is no more likely than placebo to cause seizures in individuals who reported that their seizures were provoked by aspartame consumption."

Anyway, that's just one study in which the evidence points away from one of the assertions that the website you linked makes.

Bottom line though, if you make a claim that a substance such as aspartame causes so many diseases, the burden of proof is on you. Simply making a claim and saying "look for yourself" isn't adequate.

<<Oh, btw....you forgot one in your list. Bread makes you fat, and evidently, unusually susceptible to inane ranting and raving.>>

Well, you did such a wonderful job cutting aspartame from your diet, now you've got a reason to stop the bread as well.

My point with the bread study (it was an old email joke I saved on my computer) was to use extremes to point out how simple it is to make relatively unfounded claims and pass them off as scientific fact. The website you linked uses more sensationalism than fact to sell a book.

Whether or not aspartame can cause Grave's Disease or signs/symptoms of Grave's Disease isn't the issue. The issue whether there's a proven association. While anecdotal evidence may be somewhat compelling, it's not proven until the appropriate scientific study supports the hypothesis.

BTW, I did do a quick search for a study involving Grave's Disease and Aspartame...found nothing. If there's no study, should one be done? Absolutely! But I'll reserve my judgment on the matter until there is clear and convincing evidence one way or the other.

[ 29. March 2004, 17:47: Message edited by: Jordan ]

[Guest F16PilotMD]

Oh, if I only had a dollar for every discusion I've had like this one...

The reason physicians in general are skeptics about this kind of thing is that we live our lives day to day based upon good science. Some things are folklore, no doubt. But, in general, we are scientific animals. Part of that is because of most of our backgrounds but some is because we are held by society to very high standards. Even simple things, if they go wrong, may be questioned by a panel of experts, etc. And they will come with good, sound, scientific evidence...not stuff from the internet. Does this behavior cause us to "miss" things like the aspartame issue. Well, maybe, but not often. In general, there exists funding for ANY study. Most--not all, but most--medical issues are not subject to some conspiracy by George Bush or anyone else.

Now, for this particular issue, you are suggesting removing a non-essential item from the diet. Like I said, go for it. If it works great. It can't hurt.

And if it doesn't, we can suggest one of the other 1,000,000 internet headache "cures" that can be found on Google.

Remember, nobody gets press-time by saying things are good. The press all goes to the people saying doom and gloom. You hear about all these bad things because that's what spins and sells. The internet is no different.

[Guest ecutch]

Lately I've been getting occasional migraines after working out. I think it's because I get dehydrated, but I drink about 64 ounces of water while in class (intel school) and drink a GNC Mega MRP shake while working out, so the dehydration thing doesn't make complete sense to me. Are there certain dietary deficiencies that cause migraines? I eat healthy (a lot of chicken and veggies) and often (I prescribe to the many small meals a few hours apart idea). Any help?

[Gravedigger]

I just took a health and personal fitness class and we discussed this issue. The teacher said that many people get headaches after working out because they aren't breathing correctly. A lot of people will hold their breath while exercising without noticing it, and that will cause really painful headaches. Next time you work out, try focusing on your breathing. If that doesn't work, maybe one of the docs can help you.

[Scooter14]

Without knowing what's in the GNC shake, I know that some of those supplements used to give me headaches. At least that was my conclusion when I stopped taking them and they went away.

I'm not sure what ingredient did it and some do it to me and some don't, hit or miss.

Try maybe Simply Whey or someting basic and move up from there, see how it works for ya.

[HerkDerka]

Ecutch-

You don't have any stats posted, but I ASSume you are going for a pilot slot. I'm going to save your career right now.

NEVER NEVER NEVER NEVER NEVER NEVER NEVER NEVER NEVER NEVER NEVER use the term "migraine" again unless you honestly think you have a brain tumor. The words "migraine" and "allergy" are the absolute best ways to get your pilot slot ripped away from you. I tell this from experience. I had a good friend in my UPT class who was getting some headaches. I think it was mainly due to less sleep and no enough fluids.

Anway, he showed up to the flight doc and used the no-no word. He was immediately DNIFed and removed from training. He had to go to several clinics to receive cat scans and MRIs. He found out that it would take a minimum of six months to get an answer from the higher ups. He was sent back on casual status and given orders to Ramstein. When I was in CIQ at Little Rock, I heard that he was finally starting pilot training again (a full 1 1/2 years after the initial incident). All this just because he exaggerated about some headaches.

HD

[Guest SpacemanFry]

I have some question for people in the know regarding headaches waiver.

So here's my situation. When I was in college I had 2-3 cluster headaches episodes that were diagnosed and treated by a doc. Last one I had was in fall of 2000.

I am now applying for OTS for a pilot slot primarily. I went to do my MEPS physical in Sep and the doc there told me that as long as I give them medical records showing I haven't had any since 2000 I should be ok. Of course I send in the records and they DQ me and my recruiter said that docs at MEPS usually tell you whatever you want to hear to make sure you send in all the records. He said I can apply for a waiver and he's going to tell them to send my file for a waiver but that it will take a few months.

Now my questions are:

1. What are my chances to get a waiver if going for a pilot spot ? What about if I were going for a non-rated slot ?

2. If I do not get the waiver at first can I try again for a waiver later ?

3. Is there any way to give more supportive documentation or second opinions or whatever to my file ? Probably won't really help in this situation is causes of cluster headaches are not known for sure, but I do remember one of the doctors tell me back when I had them that a lot of the times cluster headaches in young males can be caused by hormonal changes at that age (18 or so) and go away after you pass that period. Don't know just trying to increase my odds in any way.

4. Is there any way to check "progress" of a waiver w/o bugging my recruiter ? He's quite busy with the board coming up and let's just say he's not very concerned about returning my calls now that I'm in a limbo state.

Thanks a lot to anybody that can help and shed some light on these questions.

[Guest doctidy]

1 - You do not have a good change of getting any flying position w/ cluster headaches.

2 - You can always ask a second time for a waiver. Decisions are sometimes changed, but infrequently.

3 - A second opinion helps. It would have to convince the medical authorities that the original diagnosis was wrong. If you have cluster headaches...whether they cause symptoms infrequently or not...you have cluster headaches (very profound!). See #1 above.

4 - I'd call the recruiter. Following up once a month isn't bugging him...rather shows your continued interest. And, its his job to help you!