Migraine and Chronic Headache Worksheet

FAA Clinical Checklists

Apr 2014

Guidance is compiled and interpreted by professional pilots and physicians at FlightPhysical.com from the 2014 AME Guide, FAA and FDA web data (www.FAA.gov & www.FDA.gov), instructions specified in the Aeronautical Information Manual, Federal Air Surgeon Bulletins from 1999-2015, and 14 CFR Part 61 and Part 67 (the FARs).

The AME must review a current status report by the treating physician and any supporting documents to determine the applicant's eligibility for certification. If the applicant meets ALL the acceptable certification criteria listed below, the AME can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.

Migraine and Chronic Headache Worksheet for
Item 46. Neurologic



Treating physician finds the condition stable on current regimen and no changes recommended

[ ] Yes

Acceptable Types of Migraine or Headache

[ ] Classic/Common Migraine, Chronic Tension headache, Cluster headache

NOT acceptable: Ocular migraine, complicated migraine


[ ] No more than one episode per month


[ ] Only mild symptoms controlled with medication(s) listed below.

[ ] In the last year:

  • no in-patient hospitalizations
  • no more than 2 outpatient clinic/urgent care visits for exacerbations (with symptoms fully resolved)

NOT acceptable: neurological or TIA-type symptoms; vertigo; syncope; and/or mental status change

Medications - Preventive

[ ] None; or daily calcium channel blockers or beta blockers only for prophylaxis without side effects

Medications - Abortive

[ ] OTC headache medications; warn airman:

24 hour no-fly - Triptans

36 hour no-fly - Metoclopramide (Reglan);

96 hour no-fly - promethazine (Phenergan)

NOT acceptable: Injectable medications and narcotics

AME MUST NOTE in Block 60 one of the following:

[ ] Airman meets certification criteria for migraine and chronic headaches.

[ ] Airman had a previous Special Issuance for this condition and now meets the regular issuance certification criteria for migraine and chronic headache.

[ ] Airman does NOT meet certification criteria for migraine and chronic headaches. I have deferred this exam. (Mail the supporting documents to FAA identifying which criteria were not met.)

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