Fly Well: Oh, my aching head

Don’t let headaches ground you

October 1, 2013

Jonathan SackierAircraft maintenance bills cause headaches and paperwork is a pain in the neck, agreed? Head pain is extremely common, perhaps explaining why we link distasteful life experiences to uncomfortable sensations above the neck.

The brain does not “feel” pain but the surrounding membranes (meninges), the skull, periosteum (bone lining), sinuses, muscles, ears, and eyes do. In 2005 the International Headache Society produced a classification: Primary, arising with no cause (migraine, tension, and cluster headaches); secondary, where something structural is to blame; and tertiary, which describes other causes. Tension headaches are most common, probably resulting from scalp and neck muscular contraction in response to stress and are experienced by four out of five women and two out of three men. Best treated by acetaminophen or anti-inflammatories, know that some medicines contain caffeine, which might cause rapid heartbeat, and others include anti-histamines—avoid these prior to flight. Self-ground until you’ve recovered, but if it’s more than an occasional pain, see your physician in case something more serious is going on. If classified as chronic, more than one a month, your AME needs to know.

Miserable migraines afflict 12 percent of people, three times more women than men after puberty. Often commencing with visual disturbances, they induce vomiting demanding the victim lie in a quiet, dark room.

Cluster headaches occur in groups sometimes for months, then abating for years. These beasts behave predictably, waking one from sleep or barging in the same time each day. They are possibly caused by a misbehaving area of the brain, the hypothalamus, and the release of histamine and serotonin, chemicals impacting bodily function. Running in families, the severe gripping pain felt behind the eye lasts around an hour, potentially provoked by nitrite-rich foods (smoked meats, chocolate), alcohol, smoking, and taking nitroglycerine for heart disease. Your doctor will make the diagnosis by taking a detailed medical history and, if present during a headache, may see one eye red and watering and a runny nostril. Cluster headaches are tricky to treat but oxygen at the outset, caffeine and drugs such as the triptans (Zomig or Imitrex) or ergotamines (e.g. Migranal) may help. Preventative drugs including steroids, antidepressants, beta blockers, epilepsy medications, and calcium channel blockers (e.g. Verelan, Calan) might head clusters or migraines off at the pass. Your AME can issue your medical if clusters are in your life, but there are constraints including attack frequency and absence of other neurological symptoms. Some of these medicines are allowable, others impose restrictions so check AOPA’s medication list. Simply taking analgesics more than twice a week can have implications.

Secondary headaches are caused by something else going on inside the head or neck, and may also produce nausea, vomiting, and other symptoms. Examples are brain tumors, aneurysms, (blood vessel weak spots), infections (sinuses or meningitis), dental caries, post-concussion bleeding inside the head, and rebound from taking too many pain drugs. If headaches occur early in the morning, recur, or are associated with other symptoms, see your doctor promptly.

Tertiary headaches include facial neuralgia, (nerve pain) most commonly afflicting the trigeminal nerve causing intense pain on the cheek, around one eye, and half the forehead.

Head-butting a deployed flap during preflight will dent your ego, if not the control surface, and may cause throbbing sensations. After head trauma, defer flight because bleeding into, or around the brain might ensue, with later collapse or seizure; not something to contemplate while busting a hole in the sky.

The FAR/AIM characterizes altitudes and intervals above and beyond which pilots and passengers should have available, and use, supplemental oxygen. I recommend more liberal oxygen use as headaches, especially after lengthy flight, are worsened by hypoxia, lack of oxygen. There are no downsides to using it other than very minimal cost. Cockpits are noisy; noise canceling headsets are a sound investment to reduce front office din. Advocating sterile cockpit rules reduces stress and headaches. As an aircraft climbs we enter drier, colder air where breath moisture is lost more readily, so prevent headaches by keeping well hydrated.

Email jonathan.sackier@aopa.org

Jonathan Sackier