- Cluster-like Headache Attributed to Pituitary Apoplexy
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Jae-Han Bae, Jeong-Min Kim, Oh-Sang Kwon, g Chul Youn, Hae-Bong Jeong
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Published online December 31, 2015
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 Abstract
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- 뇌하수체졸중으로 기인한 군발 유사 두통
- Migraine Management in Pilots: A Focused Narrative Review for the Treating Neurologist
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Chan-Young Park, Dongwook Kang, Heejung Lim, Hae-Bong Jeong, Kwang-Yeol Park
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Received May 6, 2026 Accepted June 1, 2026 Published online June 9, 2026
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DOI: https://doi.org/10.62087/hpr.2026.0019
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Abstract
- Migraine, one of the leading global causes of disability, presents a complex challenge in aviation medicine. Headache is the fourth most common cause of in-flight pilot incapacitation, and cockpit-related exposures—including hypobaric hypoxia, low humidity, circadian disruption, and, in military aviation, sustained +Gz loading—may lower the migraine threshold. At the same time, aeromedical regulations restrict the medication options available to treating neurologists. This focused narrative review synthesizes pilot-specific clinical evidence and the principal regulatory documents issued by the International Civil Aviation Organization (ICAO Annex 1 and Doc 8984) and the U.S. Federal Aviation Administration (FAA Aviation Medical Examiner Guide) to provide neurologists with a practical framework for managing pilots with migraine. Simple analgesics, including acetaminophen/paracetamol, ibuprofen, naproxen, and aspirin at standard doses, are permitted under both ICAO and FAA frameworks. Triptans are permitted by the FAA after a 24- to 48-hour ground-observation period, whereas gepants such as ubrogepant and rimegepant require a 48-hour observation period. Beta-adrenergic blockers and calcium channel blockers are accepted preventive agents under both frameworks after a 7-day ground trial, whereas tricyclic antidepressants, topiramate, valproate, opioids, and butalbital-containing compounds are unacceptable. Anti–calcitonin gene-related peptide monoclonal antibodies are now accepted by the FAA after a 7-day ground trial, providing an additional certification-compatible option for pilots with migraine refractory to traditional preventive therapy. Most pilots with migraine can be managed in a manner compatible with continued flight duty when the neurologist selects medications within the applicable aeromedical formulary and documents clinical stability objectively to support certification.
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