CACI Migraine and Other Headaches | Migraine headaches are a common ailment that affects up to 15 percent of the population and occur much more commonly in women [1]. Taken together with tension headaches which rank number two as the most common disorder in the world [2], cluster headaches, and other causes, there is a good chance you will need to check “yes” to the FAA’s question about “Frequent or severe headaches” in MedXPress.

If you find yourself in that situation, your AME may still be able to issue your certificate on the same day of your exam. The FAA has included all common causes of headaches as one of the Conditions AMEs Can Issue (CACI). As with all CACIs, the FAA has provided AMEs with a set of predetermined criteria that allows them to issue medical certificates to pilots even when they have certain well-controlled medical conditions.

For headaches, here are the criteria you need to meet [3]:

• Your treating physician needs to document that your headaches and the medications used to control them are stable

• Your headaches need to be classified as common migraines, tension headaches, or cluster headaches

• Your headaches must happen monthly or less

• In the past year, you must not have been hospitalized for headaches or had more than two outpatient visits to address them.

• If you take any medications to prevent headaches, only calcium channel blockers or beta blockers – types of common blood pressure medications – are allowed.

• Your headaches must be controlled with over-the-counter medications like ibuprofen, naproxen, or acetaminophen. If you use prescription medications, make sure to check here to verify how long to wait before getting in the cockpit.

As CACIs go, this one is pretty straightforward. Basically, your doctor needs to be done adjusting your medications, your headaches have to happen monthly or less and you need to be using common medications for treatment.

If the pattern and severity of your headaches do not meet the FAA’s CACI criteria, it is probably a good idea to discuss them in more detail with your primary care physician. Frequent headaches could indicate a number of other medical conditions like uncontrolled high blood pressure, obstructive sleep apnea, chronic fatigue, emotional stress, or medication side effects that should be addressed before focusing exclusively on treating your headache pain. Some features like sudden severe headaches, new headaches especially for those over 50, changes in your cognitive ability or personality, and vision changes among others can signal potentially life-threatening conditions. Your health should always come before your medical certificate.

With an otherwise clean bill of health from your doctor, it is still possible to receive a special issuance from the FAA even if your headaches and your treatment regimen do not fit neatly within the CACI criteria outlined above. That process can take anywhere from days to months or longer depending on your unique situation and how the submission is handled by your AME. If you have any questions about that process or your FAA medical certification, contact us, or an AME you trust, to find out more.

References:
[1] R. B. Lipton, W. F. Stewart, S. Diamond, M. L. Diamond, and M. Reed, “Prevalence and burden of migraine in the United States: data from the American Migraine Study II,” Headache, vol. 41, no. 7, pp. 646–657, Aug. 2001, doi: 10.1046/j.1526-4610.2001.041007646.x.

[2] P. Martelletti, G. L. Birbeck, Z. Katsarava, R. H. Jensen, L. J. Stovner, and T. J. Steiner, “The Global Burden of Disease survey 2010, Lifting The Burden and thinking outside-the-box on headache disorders,” J Headache Pain, vol. 14, p. 13, Feb. 2013, doi: 10.1186/1129-2377-14-13.

[3] “Guide for Aviation Medical Examiners – Item 46.” https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/app_process/exam_tech/item46/amd/ha/ (accessed Feb. 06, 2022).