Migraine History and Recurrence in Military Pilot Applicants.

Migraine is a common condition with features that can adversely impact aviation activities. The diagnosis of migraine is often compatible with civil aviation training, but is much more concerning for military pilot applicants. A history of migraine headache traditionally medically excluded potential military pilot applicants due to unpredictability of occurrence and potential for operational distraction or incapacitation. Medical standards and policy applications have been quite variable, ranging from total exclusion for even one headache occurrence to as low as a 1-yr migraine-free period before consideration. In many instances, policy application has been subjective and not based on objective evidence. This presents a challenge to waiver authorities and also potentially sends a mixed message to command authorities. There is essentially no current literature evidence applicable to the aviation population on migraine occurrence risk. This study reviewed 71 U.S. Air Force pilot applicants who were diagnosed with migraine and had been granted waivers to assess any predictive factors for migraine recurrence and its aeromedical impact. Only three applicants had recurrence after waiver was granted, with two of these occurring within 2 yr of their last reported migraine event, and all recurrences noted within 3 yr. Data indicated favorable risk with suitable migraine-free observation before military pilot training, which could be incorporated into aeromedical standards and policies.