Gliding and migraines?

On Jul 19, 6:52*am, K6Chris k6chris(AT)live(DOT)co(DOT)UK wrote:
Having suffered my first ever migraine last night and specifically the
visual disturbance (aura) that came with it, I am keen to discover how
gliders pilots who are prone to migraines cope? *Although sufferers are
allowed to drive and indeed fly, the advice for coping of 'pull over'
seems less than helpful!

Any advice and experiences most welcome!

Chris

--
K6Chris

One of the things that keeps me from paying close attention to this
forum is the high volume of chaff from ignorant, opinionated typists
that cannot suppress the urge to make a response to a post that
strikes a chord, whether or not they have anything factual to offer.
Years ago, when email was new, two colleagues had a "conversation"
that began with a single post-it note from one to the other, and ended
with a concatenation of post-its from the lintel to the floor of one's
door. They called it "virtual email." It was pretty entertaining, like
the stream-of-consciousness replies to Chris's question.

(I am a general internist and a senior AME.)

1: Headaches (of which vascular headaches are the most common, and
migraine a particular type of "vascular" headache) -- headaches of all
types come in the broadest spectrum from trivial to annoying to
disabling.
2: It's the disabling ones that are disqualifying to the FAA, as
unanticipated abrupt in-flight incapacitation is of intense interest
to the passengers, the pilot's mom and spouse (et al) and to the folks
on the ground under the aircraft.
3: The FAA (and NTSB) understand that piloting an aircraft safely
involves the brain -- whose proper operation not only involves clear
thinking, but also motor coordination and spatial orientation -- both
of which, you may have noticed, are important in safe flight and
landing. Either headaches or the medications used to treat them may
impair the brain's coordination / perception / reasoning / judgment
functions. ANYTHING that has been shown scientifically to impair brain
function is not a good idea to combine with piloting, and as a general
rule is not permitted by the FAA (how could they responsibly *approve*
an impairing substance?)
4: Vascular headaches, in general, are best treated (best prevented)
with LIFESTYLE rather than with medications, though medications are
very, very useful.
A: the most important migraine prevention is DAILY, pleasantly
vigorous exercise. Yes. Exercise. Consistently.
B: another very important prevention is a CONSISTENT diurnal
schedule: awaken at the same time every day; go to bed as soon as
tired, about the same time every day. Eat meals in consistent amounts
and at consistent times. I know it sounds boring, but it really helps.
C: Drugs in your life:
1: caffeine and theobromine (chocolate) -- Either avoid these, or
take them in the same amount every day. Variation seems to be a
problem
2: alcohol is metabolized to aldehyde: alcohol is a vasodilator;
aldehyde is a vasoconstrictor -- either may cause or exacerbate
headache. Again, avoid or be consistent.
3: Other substances in foods: capsaicin (pepper), glutamate,
sodium, and many other things, either directly or through allergy, may
play a role. Your mileage will differ, and all you can do is to
exclude and re-introduce suspect foods one by one as a personal
experiment
4: acetaminophen (paracetamol), aspirin, ibuprofen, naproxen and
ALL other pain relievers frequently worsen the headache cycle by being
taken erratically. This causes analgesic withdrawal headache, that can
be worse than the migraines were to start with. The only thing to do
is to first take these on a schedule, and then rapidly (over a few
days) taper the doses and times gradually.
5: barbiturates. These are the worst drugs for headache, as they
consistently cause persistent medication-withdrawal headaches that may
continue for life.
D: Altitude. People who are susceptible to headache often get them
at surprisingly low altitudes -- I've seen a change of 3000 ft / 1000
m precipitate headache, and I really don't know to what extent it's a
change in barometric pressure and to what extent hypoxia, except that
I've seen a person consistently develop hypoxic headache at 6000 msl
and above, completely prevented by supplemental O2 (I've seen this
often because we're married).
E: Stress. Interpersonal stress is of course important, but
sometimes the greatest stress we experience is from our own
expectations for ourselves.
5: Prescription medications are often very helpful, but are an ADJUNCT
to the other stuff, and are almost always medically disqualifying.

Self-"certification": Since 1997, we glider pilots don't have to self-
certify, but if we know we have a condition that might subject us to
in-flight incapacitation, we are required by FAR not to fly. (How
could the rule be otherwise?) In my own limited observation, I am
amazed at the sorts of impairments pilots choose to fly with. But
then, very few pilots have medical training, and even those of us who
do consistently indulge in self-deception...

I hope, Chris, that this is of some help.