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