Medical History Questions - Headache

[My Flight Surgeon]

This is the first in a series of posts about medical issues potentially affecting a pilot’s ability to obtain a medical certificate. In this series, we will look at common problems seen by the AME, review the requirements the FAA has to consider allowing one to fly and discuss what you need to do to expedite consideration by the FAA to allow you to fly. We plan to go through all of the medical history items in Section 18 on the front of Form 8500-8 over the next several months.

Headaches

Headaches are common complaints from persons presenting to the physician’s office. The majority of these is simple tension headaches and requires only medication such as acetaminophen or ibuprofen. Even if simple tension headaches are longstanding the AME can issue a medical certificate without submitting a neurological evaluation to the FAA.

Item18a (Frequent or severe headaches) on the FAA Form 8500-8 (the one you fill out in the AME’s office) asks if there is a history of frequent or severe headaches. If so, the FAA states the applicant should report frequency, duration, characteristics, severity of symptoms, neurologic manifestations, and whether they have been incapacitating, treatment and side effects, if any.

The problem arises once a pilot is diagnosed with migraines, cluster headaches, chronic tension headaches or post-traumatic headaches. All of these conditions require a decision from the FAA regarding the issuance of a medical certificate. This is true for all classes of medical certification. The problem with headaches is pain, in some conditions, may be acutely incapacitating. Chronic recurring headaches or pain syndromes often require medication for relief or prophylaxis, and, in most instances, the use of such medications are disqualifying because they may interfere with a pilot's alertness and functioning. The FAA wants to insure the condition is controlled and there are no medications that might disqualify a pilot from operating an aircraft.

If one has chronic tension headaches or cluster headaches, the FAA requires the airman to submit all pertinent medical records, a current neurologic report, to include characteristics, frequency, severity, associated with neurologic phenomena, the name and dosage of medication(s) and side effects. For post-traumatic headaches they require the pilot to submit all pertinent medical records, current neurologic report, name and dosage of medication(s) and side effects before Special Issuance is granted.

Migraine headaches are a bit different. The FAA wants to see an initial evaluation to include all pertinent medical records, current neurologic report, to include characteristics, frequency, severity, associated with neurologic phenomena, and name and dosage of medication(s) and side effects before they grant a Special Issuance medical certificate. The difference here is that once a Special Issuance is granted the AME can re-issue the medical certificate. The Special Issuance Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. For migraine headaches, AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

• An Authorization granted by the FAA;
• A statement from the treating physician regarding the frequency of headaches and/or other associated symptoms since last follow-up report;
• A statement from the treating physician regarding if the characteristics of the headaches changed; and
• The name and dosage of medication(s) used for treatment and/or prevention with comment from the treating physician regarding side effects.

If these conditions are not met, the AME must defer the decision to the FAA.

The important take home points regarding headaches include: 1) if the headaches are severe and incapacitating one should not fly until they are evaluated and this may result in a Special Issuance of the medical certificate, 2) new onset severe headaches can be a serious problem such a brain tumor or hemorrhage into the head and need urgent evaluation, 3) If one has a headache, be certain the diagnosis is accurate and do not accept a diagnosis of migraine unless the headache meets the criteria, and 4) be cautious about medications prescribed for headaches by non-AMEs. They may write a prescription for one of the SSRI class of drugs (Prozac® or Zoloft®) which will result in disqualification from flight duties. If there are any questions about the medications prescribed, talk to your AME to coordinate appropriate management of the condition.

*Italicized sections are excerpts from FAA documents.