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Migraine Prophylaxis Using Novel Monoclonal Antibody Injections in a Commercial Pilot.

Mitchell A Garber, Joseph I Sirven, Richard S Roth

Aerospace Medicine and Human Performance

|November 14, 2020

Summary

New CGRP monoclonal antibody treatments offer hope for pilots with frequent migraines. One pilot experienced complete remission of lifelong migraines after fremanezumab injections, enabling return to flying.

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Area of Science:

Neurology
Aerospace Medicine
Pharmacology

Background:

Frequent migraines are debilitating and can disqualify individuals from aviation duties.
Four calcitonin gene-related peptide (CGRP) monoclonal antibodies have been FDA-approved since 2018 for migraine treatment.
These novel therapies offer alternatives for migraines resistant to conventional treatments.

Observation:

A 45-year-old commercial pilot with severe, frequent migraines (13-15/month) despite standard treatments was grounded.
The pilot received monthly subcutaneous fremanezumab injections, an anti-CGRP monoclonal antibody.
Complete cessation of migraines occurred after the second injection.

Findings:

The pilot achieved complete remission of a lifelong migraine condition.

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This represents the first reported case of successful anti-CGRP monoclonal antibody use in an active pilot.

The pilot was medically recertified by the FAA after treatment.

Implications:

Anti-CGRP monoclonal antibodies are a promising prophylactic option for pilots with challenging migraines.
Successful treatment can facilitate the return of aviators to active duty.
These medications may significantly improve the quality of life and career longevity for pilots suffering from migraines.