Visually triggered migraine headaches affect spatial orientation and balance in a helicopter pilot

The authors present a case of an attack helicopter pilot with recurrent spatial disorientation (SD) flying with night vision goggles (NVG's), diagnosed as having visually triggered migraine headaches. Serial Dynamic Platform Posturography testing during an acute migraine attack demonstrated balance dysfunction under visual and somatosensory deficient conditions, correlating with headache intensity. Vestibular symptoms are associated with migraine, and may be triggered by visual stimuli. NVG scintillations in susceptible individuals may act as a visual trigger for migraine. Migraine phenomenon may be a contributing factor to SD, especially during NVG operations. The association of visual and vestibular dysfunction with migraine and aeromedical disposition of migraine in aviators is discussed.