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

BACKGROUND: Frequent migraine headaches are disabling and aeromedically disqualifying. Four new monoclonal antibody medications, targeting calcitonin gene-related peptide (CGRP), have been approved by the U.S. Food and Drug Administration (FDA) since 2018, with more expected in the coming years. These medications present new alternatives for the treatment of migraine unresponsive to other therapeutic and prophylactic agents.CASE REPORT: We present a case of a 45-yr-old commercial pilot who presented with migraine headaches increasing in frequency to 1315 per month in spite of the use of propranolol for prophylaxis and sumatriptan for abortive treatment of the headaches. Upon presentation, he was not flying due to his frequent headaches and he was started on monthly subcutaneous injections of fremanezumab. Following his second injection, his headaches stopped entirely, and he has continued on the medication and not experienced another migraine headache. He underwent an aeromedical neurology evaluation and consideration for Authorization of Special Issuance of Medical Certificate, which was granted by the Federal Aviation Administration (FAA).DISCUSSION: This is the first case to our knowledge of the successful use of an anti-CGRP monoclonal antibody medication in an active pilot. The pilot appears to be a super responder to the medication, having achieved complete remission of a nearly life-long condition. Though only a small portion of treated individuals will see this sort of response, these medications represent an effective additional option for migraine prophylaxis in the pilot population.Garber MA, Sirven JI, Roth RS, Hemphill JM. Migraine prophylaxis using novel monoclonal antibody injections in a commercial pilot. Aerosp Med Hum Perform. 2020; 91(10):824825.

Postmortem ethanol in the setting of ethanol-containing automotive fuel.

The pilot of a light aircraft that crashed after a loss of power was found to have ethanol in the vitreous and the blood, but almost none in the urine. The globes of the eyes were intact, and the body was refrigerated after recovery until the autopsy was performed the following morning. The pilot was described as a "nondrinker," and additional specialized toxicology testing results were inconsistent with ethanol ingestion. The pilot's body was extensively exposed to fuel during the prolonged extraction. Investigation determined that the aircraft had been fueled with gasoline that contained 10% ethanol. Although exposure to automotive fuel has not been previously described as a source of ethanol in postmortem specimens, it may represent a source for the ethanol detected during postmortem toxicology testing in this case, and this finding may be relevant to other cases with similar exposure.

Medical guidelines for space passengers--II.

It now appears likely that commercial entities will carry paying passengers on suborbital spaceflights in this decade. The stresses of spaceflight, the effects of microgravity, and the limited capability for medical care onboard make it advisable to develop a system of medical clearance for such space tourists. The Aerospace Medical Association, therefore, organized a Space Passenger Task Force whose first report on medical guidelines was published in 2001. That report consisted of a list of conditions that would disqualify potential passengers for relatively long orbital flights. The Task Force reconvened in 2002 to focus on less stringent medical screening appropriate for short duration suborbital flights. It was assumed that such commercial flights would involve: 1) small spacecraft carrying 4-6 passengers; 2) a cabin maintained at sea-level "shirt-sleeve" condition; 3) maximum accelerations of 2.0-4.5 G; 4) about 30 min in microgravity. The Task Force addressed specific medical problems, including space motion sickness, pregnancy, and medical conditions involving the risk of sudden incapacitation. The Task Force concluded that a medical history should be taken from potential passengers with individualized follow-up that focuses on areas of concern.