Migraine and chronic headache
What the FAA's documents say about migraine and chronic headache, in plain words, with the FAA's own words one press away.
FAA term: Headache or Migraine (Cluster, Tension, Ocular, Acephalgic, Ophthalmic, or Retinal)
Short version
The FAA's table sorts it into three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row AStress headache or tension headache, controlled with OTC medications. | Examiner issues | Examiner can issue |
| Row BMigraine with aura (classic migraine/common migraine), chronic tension, chronic daily, or cluster. The row says older terms include acephalgic migraine, ocular migraine and ophthalmic migraine, and that classic migraine is now called migraine headache with aura. | Worksheet | CACI |
| Row CAny history of a migraine which results in disabling visual symptoms such as loss of central vision or large visual field cut (excluding migraine aura); chronic daily; complicated migraine; post-traumatic headaches; retinal migraine, which the row says spreads across the retina, where the concern is amaurosis, and was previously called ocular migraine; or vestibular migraine. | Defers to the FAA | Special Issuance |
Show the FAA's words: the FAA's table for Migraine and chronic headache
- Row A · Examiner can issue
Stress headache or tension headache, controlled with OTC medications. If the examiner can determine the condition is mild and under control -- an average of less than two headache days per month; medications acceptable (seldom requiring more than OTC analgesics); not incapacitating (no symptoms that would interfere with flight duties); and not associated with any neurological findings -- the table says ISSUE, and has the examiner annotate this information in Block 60.
A. Stress Headache Tension Headache Controlled with OTC meds … If the AME can determine the condition is: mild and under control: • Average of less than two headache days per month; • Medications are acceptable (seldom requiring more than OTC analgesics); • Is not incapacitating (The individual has no symptoms that would interfere with flight duties.); and • Not associated with any neurological findings: … ISSUE Annotate this information in Block 60.
- Row B · CACI
Migraine with aura (classic migraine/common migraine), chronic tension, chronic daily, or cluster. The row says older terms include acephalgic migraine, ocular migraine and ophthalmic migraine, and that classic migraine is now called migraine headache with aura. The table sends the examiner to the CACI worksheet for migraine and chronic headache, and says this will require a current, detailed clinical progress note from the treating physician or neurologist. If the pilot meets all the worksheet's criteria and is otherwise qualified, the table says ISSUE with no time limitation; the examiner annotates the correct CACI statement in Block 60 and keeps the required supporting information on file.
B. Migraine with aura (Classic migraine/ Common Migraine) OR Chronic tension OR Chronic daily OR Cluster OR (Older terms include acephalgic migraine, ocular migraine, ophthalmic migraine Classic migraine is now called migraine headache with aura.) … See the CACI-Migraine and Chronic Headache Worksheet. This will require a current, detailed Clinical Progress Note from the treating physician or neurologist. … If the pilot meets all CACI worksheet criteria and is otherwise qualified ISSUE with no time limitation Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row C · Special Issuance
Any history of a migraine which results in disabling visual symptoms such as loss of central vision or large visual field cut (excluding migraine aura); chronic daily; complicated migraine; post-traumatic headaches; retinal migraine, which the row says spreads across the retina, where the concern is amaurosis, and was previously called ocular migraine; or vestibular migraine. The table lists what to submit for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance.
Any history of a migraine which results in disabling visual symptoms such as loss of central vision or large visual field cut (excluding migraine aura) OR Chronic daily, OR Complicated migraine, OR Post-traumatic headaches, OR Retinal migraine. (This type spreads across the retina and the concern is Amaurosis). Previously called ocular migraine. OR Vestibular migraine … Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance.
- A note on the table, 1
The table's notes, above its last row, say pain, in some conditions, may be acutely incapacitating, and that chronic recurring headaches or pain syndromes often require medication for relief or prophylaxis, and, in most instances, the use of such medications is disqualifying because they may interfere with a pilot's alertness and functioning.
Notes: Pain, in some conditions, may be acutely incapacitating. Chronic recurring headaches or pain syndromes often require medication for relief or prophylaxis, and, in most instances, the use of such medications is disqualifying because they may interfere with a pilot's alertness and functioning.
- A note on the table, 2
The note in the last row says that if associated with a seizure, see the seizure section. It says chronic recurring headaches or pain syndromes often require medication for relief or prophylaxis, and, in some instances, the use of such medications is disqualifying because they may interfere with the individual's alertness and functioning, and that in some conditions, pain may be incapacitating. Where the notes above the row say "in most instances", this note says "in some instances"; both are as published.
Note: If associated with a seizure – see seizure section. Chronic recurring headaches or pain syndromes often require medication for relief or prophylaxis, and, in some instances, the use of such medications is disqualifying because they may interfere with the individual's alertness and functioning. In some conditions, pain may be incapacitating.
Chronic recurring headaches or pain syndromes often require medication for relief or prophylaxis, and, in most instances, the use of such medications is disqualifying
The FAA pathways for migraine and chronic headache
- How this pathway works: Examiner can issueNo special pathwayRow A
- How this pathway works: CACIConditions AMEs Can IssueRow B
- How this pathway works: Special IssuanceAuthorization for Special Issuance of a Medical CertificateRow C
- How this pathway works: AASIAME Assisted Special IssuanceAfter the FAA decides
Which exam
Your step-by-step plan
Step 1: The progress note from the treating doctor or specialist
The note the examiner reviews, and what it verifies.Within 90 days before the examA current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam, explaining every item on the worksheet. Your AME reviews it.
It verifies
- Stable on the current regimen, with no management changes recommended
- Migraine (with or without aura), tension headache or cluster headache
How often
- Episodes
- No more than one a month
- Outpatient clinic or urgent care visits for symptom exacerbation, last 12 months
- No more than 2, even if symptoms fully resolved
- In-patient hospitalizations for headaches
- No history
Symptoms
- Only mild non-disabling symptoms
- No symptoms that functionally impair vision
- Not: Any neurological impairment or TIA-type symptoms
- Not: Auras without headaches
- Not: Impairment of central vision, or functionally significant impairment of peripheral vision
- Not: Vertigo, syncope or mental status change
Show the FAA's words: The progress note from the treating doctor or specialist
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam which explains all items below.
FAA source: CACI – Migraine and Chronic Headache Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.
A current, detailed clinical progress note from the treating physician verifies: [ ] The condition stable on current regimen and no management changes are recommended.
FAA source: CACI – Migraine and Chronic Headache Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.
Type of headache [ ] Migraine (with or without aura), tension headache, cluster headache.
FAA source: CACI – Migraine and Chronic Headache Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.
Frequency and severity [ ] No more than one episode per month [ ] In the last 12 months, no more than 2 outpatient clinic/urgent care visits for symptom exacerbation (even if symptoms fully resolved) [ ] No history of in-patient hospitalizations for headaches.
FAA source: CACI – Migraine and Chronic Headache Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.
Symptoms [ ] Only mild non-disabling symptoms. [ ] No symptoms that functionally impair vision. [ ] NONE of the following: • Any neurological impairment or TIA-type symptoms; • Auras WITHOUT headaches; • Impairment of central vision or functionally significant impairment of peripheral vision; • Vertigo; syncope; or mental status change.
FAA source: CACI – Migraine and Chronic Headache Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.
Step 2: Medications and treatment
Preventive and relief medications, TENS units, and their no-fly times.Your preventive medications
None, or any of the kinds the worksheet lists, alone or in combination, with no side effects and a completed ground trial.
The kinds listed
- ACE inhibitors (ACE-I)
- Angiotensin receptor blockers (ARB)
- Beta blockers
- Calcium channel blockers (CCB)
- CGRP antagonists used only for prevention (prophylaxis)
- Not: Tricyclic antidepressants (TCAs)
- Not: Anticonvulsants
Your relief or rescue medications
None; OTC headache medications; other modalities such as heat, traction, acupressure and massage devices; or one or more of the medications listed, each with its no-fly time.
No-fly times
- 24 hours
- 48 hours
- 36 hours
- 24 hours
- 96 hours
- 24 hours
Not acceptable
- Not: Narcotics
- Not: Fiorinal, Fioricet or Midrin
A TENS unit
If a TENS unit is used.
If a TENS unit is used.
None, or a TENS unit (such as Cefaly, gammaCore, Relivion MG or Nerivio) used alone or with acceptable adjunctive medications.
No-fly times
- 8 hours
- 24 hours
Not acceptable if the device causes sedation or cognitive changes.
Show the FAA's words: Medications and treatment
Medications - Preventive NOT acceptable: Tricyclic antidepressants (TCAs), anticonvulsants [ ] None or any of the following alone or in combination, provided no side effects and completed ground trial. • ACE inhibitors (ACE-I) • Angiotensin receptor blockers (ARB) • Beta blockers • Calcium channel blockers (CCB), • CGRP antagonists used only for prevention (prophylaxis).
FAA source: CACI – Migraine and Chronic Headache Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.
Medications or treatment - Relief/Rescue NOT acceptable: Narcotics, Fiorinal, Fioricet, or Midrin. Detailed list of migraine medications and no fly/no SRD time after use can be found Pharmaceuticals - Migraine Medications [ ] None; or Over the Counter (OTC) headache medications; or other modalities such as heat, traction, acupressure, and massage devices, to prevent, stop, and treat headaches. OR [ ] One or more of the following: • Triptans (monotherapy or with NSAID combination) 24 hour no-fly Except eletriptan (Relpax) and frovatriptan (Frova): 48 hours • metoclopramide (Reglan): 36 hour no-fly • ondansetron (Zofran): 24 hour no-fly • promethazine (Phenergan): 96 hour no-fly • Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist with 24 hour no fly time: ubrogepant (Ubrelvy); Rimegepant (Nurtec)
FAA source: CACI – Migraine and Chronic Headache Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.
Transcutaneous electrical nerve stimulation (TENS) units (such as Cefaly, gammaCore, Relivion MG, or Nerivio) [ ] None OR Used alone or with acceptable adjunctive medications. • Prevention (prophylactic) use: 8 hour no fly • Relief/Rescue and therapeutic use: 24 hour no-fly NOT acceptable: If device causes sedation or cognitive changes.
FAA source: CACI – Migraine and Chronic Headache Worksheet. FAA date 26 August 2026; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
If the examiner can determine the condition is mild and under control -- an average of less than two headache days per month; medications acceptable (seldom requiring more than OTC analgesics); not incapacitating (no symptoms that would interfere with flight duties); and not associated with any neurological findings -- the table says ISSUE, and has the examiner annotate this information in Block 60.
Row BWorksheetCACI
The table sends the examiner to the CACI worksheet for migraine and chronic headache, and says this will require a current, detailed clinical progress note from the treating physician or neurologist. If the pilot meets all the worksheet's criteria and is otherwise qualified, the table says ISSUE with no time limitation; the examiner annotates the correct CACI statement in Block 60 and keeps the required supporting information on file.
Row CDefers to the FAASpecial Issuance
The table lists what to submit for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Stress headache or tension headache, controlled with OTC medications. If the examiner can determine the condition is mild and under control -- an average of less than two headache days per month; medications acceptable (seldom requiring more than OTC analgesics); not incapacitating (no symptoms that would interfere with flight duties); and not associated with any neurological findings -- the table says ISSUE, and has the examiner annotate this information in Block 60.
A. Stress Headache Tension Headache Controlled with OTC meds … If the AME can determine the condition is: mild and under control: • Average of less than two headache days per month; • Medications are acceptable (seldom requiring more than OTC analgesics); • Is not incapacitating (The individual has no symptoms that would interfere with flight duties.); and • Not associated with any neurological findings: … ISSUE Annotate this information in Block 60.
- Row B · CACI
Migraine with aura (classic migraine/common migraine), chronic tension, chronic daily, or cluster. The row says older terms include acephalgic migraine, ocular migraine and ophthalmic migraine, and that classic migraine is now called migraine headache with aura. The table sends the examiner to the CACI worksheet for migraine and chronic headache, and says this will require a current, detailed clinical progress note from the treating physician or neurologist. If the pilot meets all the worksheet's criteria and is otherwise qualified, the table says ISSUE with no time limitation; the examiner annotates the correct CACI statement in Block 60 and keeps the required supporting information on file.
B. Migraine with aura (Classic migraine/ Common Migraine) OR Chronic tension OR Chronic daily OR Cluster OR (Older terms include acephalgic migraine, ocular migraine, ophthalmic migraine Classic migraine is now called migraine headache with aura.) … See the CACI-Migraine and Chronic Headache Worksheet. This will require a current, detailed Clinical Progress Note from the treating physician or neurologist. … If the pilot meets all CACI worksheet criteria and is otherwise qualified ISSUE with no time limitation Annotate the correct CACI statement in Block 60 and keep the required supporting information on file.
- Row C · Special Issuance
Any history of a migraine which results in disabling visual symptoms such as loss of central vision or large visual field cut (excluding migraine aura); chronic daily; complicated migraine; post-traumatic headaches; retinal migraine, which the row says spreads across the retina, where the concern is amaurosis, and was previously called ocular migraine; or vestibular migraine. The table lists what to submit for FAA review. The examiner defers and submits the information to the FAA for a possible Special Issuance.
Any history of a migraine which results in disabling visual symptoms such as loss of central vision or large visual field cut (excluding migraine aura) OR Chronic daily, OR Complicated migraine, OR Post-traumatic headaches, OR Retinal migraine. (This type spreads across the retina and the concern is Amaurosis). Previously called ocular migraine. OR Vestibular migraine … Submit the following for FAA review: … DEFER Submit the information to the FAA for a possible Special Issuance.
The CACI worksheet's criteria
Progress note
It verifies
- Stable on the current regimen, with no management changes recommended
- Migraine (with or without aura), tension headache or cluster headache
How often
- Episodes
- No more than one a month
- Outpatient clinic or urgent care visits for symptom exacerbation, last 12 months
- No more than 2, even if symptoms fully resolved
- In-patient hospitalizations for headaches
- No history
Symptoms
- Only mild non-disabling symptoms
- No symptoms that functionally impair vision
- Not: Any neurological impairment or TIA-type symptoms
- Not: Auras without headaches
- Not: Impairment of central vision, or functionally significant impairment of peripheral vision
- Not: Vertigo, syncope or mental status change
Your preventive medications
- ACE inhibitors (ACE-I)
- Angiotensin receptor blockers (ARB)
- Beta blockers
- Calcium channel blockers (CCB)
- CGRP antagonists used only for prevention (prophylaxis)
- Not: Tricyclic antidepressants (TCAs)
- Not: Anticonvulsants
Your relief or rescue medications
No-fly times
- 24 hoursTriptans (monotherapy or with NSAID combination)
- 48 hoursEletriptan (Relpax) and frovatriptan (Frova)
- 36 hoursMetoclopramide (Reglan)
- 24 hoursOndansetron (Zofran)
- 96 hoursPromethazine (Phenergan)
- 24 hoursCGRP receptor antagonist: ubrogepant (Ubrelvy), rimegepant (Nurtec)
Not acceptable
- Not: Narcotics
- Not: Fiorinal, Fioricet or Midrin
A TENS unit
- 8 hoursPrevention (prophylactic) use
- 24 hoursRelief/rescue and therapeutic use
Not acceptable if the device causes sedation or cognitive changes.
Show the FAA's words: the CACI worksheet's criteria for Migraine and chronic headache
- Stable on the current regimen, with no management changes recommended
FAA criterion: the current, detailed progress note from the treating physician verifies the condition stable on the current regimen, with no management changes recommended.
A current, detailed clinical progress note from the treating physician verifies: [ ] The condition stable on current regimen and no management changes are recommended.
- The type of headache
FAA criterion: the type of headache is migraine (with or without aura), tension headache, or cluster headache.
Type of headache [ ] Migraine (with or without aura), tension headache, cluster headache.
- How often, and how severe
FAA criterion: no more than one episode per month; in the last 12 months, no more than 2 outpatient clinic/urgent care visits for symptom exacerbation (even if symptoms fully resolved); and no history of in-patient hospitalizations for headaches.
Frequency and severity [ ] No more than one episode per month [ ] In the last 12 months, no more than 2 outpatient clinic/urgent care visits for symptom exacerbation (even if symptoms fully resolved) [ ] No history of in-patient hospitalizations for headaches.
- Only mild non-disabling symptoms, and none of the symptoms the worksheet lists
FAA criterion: only mild non-disabling symptoms; no symptoms that functionally impair vision; and none of the following -- any neurological impairment or TIA-type symptoms; auras without headaches; impairment of central vision or functionally significant impairment of peripheral vision; vertigo, syncope, or mental status change.
Symptoms [ ] Only mild non-disabling symptoms. [ ] No symptoms that functionally impair vision. [ ] NONE of the following: • Any neurological impairment or TIA-type symptoms; • Auras WITHOUT headaches; • Impairment of central vision or functionally significant impairment of peripheral vision; • Vertigo; syncope; or mental status change.
- Preventive medications
FAA criterion: preventive medications are none, or any of the following alone or in combination, provided no side effects and a completed ground trial: ACE inhibitors (ACE-I); angiotensin receptor blockers (ARB); beta blockers; calcium channel blockers (CCB); CGRP antagonists used only for prevention (prophylaxis). The worksheet names tricyclic antidepressants (TCAs) and anticonvulsants as not acceptable.
Medications - Preventive NOT acceptable: Tricyclic antidepressants (TCAs), anticonvulsants [ ] None or any of the following alone or in combination, provided no side effects and completed ground trial. • ACE inhibitors (ACE-I) • Angiotensin receptor blockers (ARB) • Beta blockers • Calcium channel blockers (CCB), • CGRP antagonists used only for prevention (prophylaxis).
- Relief or rescue medications and treatment, and their no-fly times
FAA criterion: relief/rescue medications or treatment are none; or over the counter (OTC) headache medications; or other modalities such as heat, traction, acupressure, and massage devices, to prevent, stop, and treat headaches. Or one or more of the following: triptans (monotherapy or with NSAID combination), 24 hour no-fly, except eletriptan (Relpax) and frovatriptan (Frova), 48 hours; metoclopramide (Reglan), 36 hour no-fly; ondansetron (Zofran), 24 hour no-fly; promethazine (Phenergan), 96 hour no-fly; a calcitonin gene-related peptide (CGRP) receptor antagonist with a 24 hour no fly time, ubrogepant (Ubrelvy) or rimegepant (Nurtec). The worksheet names narcotics, Fiorinal, Fioricet, and Midrin as not acceptable, and points to the FAA's Migraine Medications page for a detailed list of migraine medications and the no fly/no SRD time after use.
Medications or treatment - Relief/Rescue NOT acceptable: Narcotics, Fiorinal, Fioricet, or Midrin. Detailed list of migraine medications and no fly/no SRD time after use can be found Pharmaceuticals - Migraine Medications [ ] None; or Over the Counter (OTC) headache medications; or other modalities such as heat, traction, acupressure, and massage devices, to prevent, stop, and treat headaches. OR [ ] One or more of the following: • Triptans (monotherapy or with NSAID combination) 24 hour no-fly Except eletriptan (Relpax) and frovatriptan (Frova): 48 hours • metoclopramide (Reglan): 36 hour no-fly • ondansetron (Zofran): 24 hour no-fly • promethazine (Phenergan): 96 hour no-fly • Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist with 24 hour no fly time: ubrogepant (Ubrelvy); Rimegepant (Nurtec)
- Transcutaneous electrical nerve stimulation (TENS) units, and their no-fly times
FAA criterion: for transcutaneous electrical nerve stimulation (TENS) units (such as Cefaly, gammaCore, Relivion MG, or Nerivio), none, or used alone or with acceptable adjunctive medications: prevention (prophylactic) use, 8 hour no fly; relief/rescue and therapeutic use, 24 hour no-fly. The worksheet says a TENS unit is not acceptable if the device causes sedation or cognitive changes.
Transcutaneous electrical nerve stimulation (TENS) units (such as Cefaly, gammaCore, Relivion MG, or Nerivio) [ ] None OR Used alone or with acceptable adjunctive medications. • Prevention (prophylactic) use: 8 hour no fly • Relief/Rescue and therapeutic use: 24 hour no-fly NOT acceptable: If device causes sedation or cognitive changes.
If the examiner defersSpecial Issuance
The table's last row names any history of a migraine which results in disabling visual symptoms (excluding migraine aura), chronic daily, complicated migraine, post-traumatic headaches, retinal migraine and vestibular migraine, and the table marks it DEFER.
What the FAA lists to send
- Item 1. A current, detailed neurological evaluation that meets the FAA Specifications for Neurologic Evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the exam.
- Item 2. An MRI of the brain performed no more than one (1) year before the exam. The table says that if an MRI is contraindicated or cannot be performed, the treating neurologist should discuss why, and that if CT is used, with or without contrast is per the treating neurologist. It says to submit the interpretive report on paper and the imaging on CD in DICOM readable format, with a file named DICOMDIR in the root directory of the CD-ROM; to verify the CD will display the images before sending; and to retain a copy of all films as a safeguard if lost in the mail.
- Item 3. The number of headache days per month, per the applicant.
- Item 4. Other testing completed or deemed necessary by the treating physician.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's last row names any history of a migraine which results in disabling visual symptoms (excluding migraine aura), chronic daily, complicated migraine, post-traumatic headaches, retinal migraine and vestibular migraine, and the table marks it DEFER.
Any history of a migraine which results in disabling visual symptoms such as loss of central vision or large visual field cut (excluding migraine aura) OR Chronic daily, OR Complicated migraine, OR Post-traumatic headaches, OR Retinal migraine. … OR Vestibular migraine … DEFER Submit the information to the FAA for a possible Special Issuance.
What the FAA lists to send
- Item 1
A current, detailed neurological evaluation that meets the FAA Specifications for Neurologic Evaluation, generated from a clinic visit with the treating neurologist no more than 90 days before the exam.
A current, detailed neurological evaluation that meets FAA Specifications for Neurologic Evaluation generated from a clinic visit with the treating neurologist no more than 90 days before the AME exam.
- Item 2
An MRI of the brain performed no more than one (1) year before the exam. The table says that if an MRI is contraindicated or cannot be performed, the treating neurologist should discuss why, and that if CT is used, with or without contrast is per the treating neurologist. It says to submit the interpretive report on paper and the imaging on CD in DICOM readable format, with a file named DICOMDIR in the root directory of the CD-ROM; to verify the CD will display the images before sending; and to retain a copy of all films as a safeguard if lost in the mail.
MRI* of the brain performed no more than one (1) year before the AME exam. If an MRI is contraindicated or cannot be performed, the treating neurologist should discuss why. If CT is used, with or without contrast is per the treating neurologist. Submit the interpretive report on paper and imaging on CD in DICOM readable format (there must be a file named 'DICOMDIR' in the root directory of the CD-ROM). Please verify the CD will display the images before sending. Retain a copy of all films as a safeguard if lost in the mail.
- Item 3
The number of headache days per month, per the applicant.
Number of headache days per month per the applicant.
- Item 4
Other testing completed or deemed necessary by the treating physician.
Other testing completed or deemed necessary by the treating physician.
After the FAA decides
AASIThe AASI for migraines says an FAA physician provides the initial certification decision and grants the Authorization. After that, it says the examiner may reissue under the Authorization when the pilot provides what it lists.
Show the FAA's words: after the FAA decides
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401. … AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
What a Special Issuance is
The Guide says an Authorization for Special Issuance, valid for a specified period, may be granted at the Federal Air Surgeon's discretion to a person who does not meet the established medical standards, if the person shows to the satisfaction of the Federal Air Surgeon that the duties authorized by the class of certificate applied for can be performed without endangering public safety during the period the Authorization would be in force.
How the FAA pathways workAt later examsAASI
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second- class must provide this information annually; applicants for third- class must provide the information with each required exam.
Under an FAA Authorization, the AASI for migraines lists what the pilot provides for the examiner to reissue. That is the Authorization itself; a statement regarding the frequency of headaches and/or other associated symptoms since the last follow-up report; a statement regarding if the characteristics of the headaches changed; and the name and dosage of medication(s) used for treatment and/or prevention, with comment regarding side effects. The FAA's separate AASI page for migraine headaches lists the same four items.
Show the FAA's words: at later exams
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA; … A statement regarding the frequency of headaches and/or other associated symptoms since last follow-up report; … A statement regarding if the characteristics of the headaches changed; and … The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects.
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA; … A statement regarding the frequency of headaches and/or other associated symptoms since last followup report; … A statement regarding if the characteristics of the headaches changed; and … The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects.
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI for migraines' list for a reissue includes the Authorization the FAA granted.
Show the FAA's words: The Authorization granted by the FAA
AMEs may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA;
A statement on how often the headaches and other symptoms have come since the last report
The AASI asks for a statement regarding the frequency of headaches and/or other associated symptoms since the last follow-up report.
Show the FAA's words: A statement on how often the headaches and other symptoms have come since the last report
A statement regarding the frequency of headaches and/or other associated symptoms since last follow-up report;
A statement on whether the headaches have changed
The AASI asks for a statement regarding if the characteristics of the headaches changed.
Show the FAA's words: A statement on whether the headaches have changed
A statement regarding if the characteristics of the headaches changed; and
The name and dosage of each medication, with a comment on side effects
The AASI asks for the name and dosage of medication(s) used for treatment and/or prevention, with comment regarding side effects.
Show the FAA's words: The name and dosage of each medication, with a comment on side effects
The name and dosage of medication(s) used for treatment and/or prevention with comment regarding side effects.
What the Authorization letter comes with
The AASI says the Authorization letter comes with attachments that specify the information the treating doctors must provide for the reissue determination.
Show the FAA's words: What the Authorization letter comes with
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.
When the examiner defers a reissue
The AASI printed in the table's PDF says the examiner must defer to the AMCD or Region if the frequency of headaches and/or other symptoms increase since the last follow-up report, or if the pilot is placed on medication(s) such as isometheptene mucate, narcotic analgesic, tramadol, tricyclic-antidepressant medication, etc. The FAA's separate AASI page for migraine headaches lists the same two cases but says the examiner should defer. Crosscheck shows both as published and does not decide between them.
Show the FAA's words: When the examiner defers a reissue
The AME must defer to the AMCD or Region if: … The frequency of headaches and/or other symptoms increase since the last follow-up report; or … The applicant is placed on medication(s), such as isometheptene mucate, narcotic analgesic, tramadol, tricyclic-antidepressant medication, etc.
The Examiner should defer to the AMCD or Region if: … The frequency of headaches and/or other symptoms increase since the last followup report; or … The applicant is placed on medication(s), such as isometheptene mucate, narcotic analgesic, tramadol, tricyclic-antidepressant medication, etc.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Two copies of the worksheet differ
The two copies give different no-fly times. The copy in the table's PDF (updated 08/27/2025) gives eletriptan and frovatriptan 72 hours and CGRP receptor antagonists 48 hours, with no ondansetron line. The separate worksheet (updated 08/26/2026) gives eletriptan and frovatriptan 48 hours, CGRP receptor antagonists 24 hours and ondansetron (Zofran) 24 hours. This page's rows quote the separate worksheet; Crosscheck shows both as published and does not decide between them.
Show the FAA's words: good to know, 2
CACI - Migraine and Chronic Headache Worksheet (Updated 08/27/2025) … Except eletriptan (Relpax) and frovatriptan (Frova): 72 hours … Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist with 48 hour no fly time: ubrogepant (Ubrelvy); Rimegepant (Nurtec)
CACI - Migraine and Chronic Headache Worksheet (Updated 08/26/2026) … Except eletriptan (Relpax) and frovatriptan (Frova): 48 hours … ondansetron (Zofran): 24 hour no-fly … Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist with 24 hour no fly time: ubrogepant (Ubrelvy); Rimegepant (Nurtec)
Chronic daily appears in two rows
Row B of the table lists chronic daily with migraine with aura, chronic tension and cluster, and points to the CACI worksheet. Row C, marked DEFER, lists it too. Crosscheck shows both rows as published and does not decide between them.
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Migraine with aura (Classic migraine/ Common Migraine) OR Chronic tension OR Chronic daily OR Cluster … See the CACI-Migraine and Chronic Headache Worksheet. … OR Chronic daily, OR Complicated migraine, OR Post-traumatic headaches, … DEFER Submit the information to the FAA for a possible Special Issuance.
Ocular migraine appears in two rows
Row B of the table lists it as an older term, with acephalgic and ophthalmic migraine. Row C says retinal migraine was previously called ocular migraine. Crosscheck shows both as published.
Show the FAA's words: good to know, 4
(Older terms include acephalgic migraine, ocular migraine, ophthalmic migraine Classic migraine is now called migraine headache with aura.) … Retinal migraine. (This type spreads across the retina and the concern is Amaurosis). Previously called ocular migraine.
Two copies of the AASI differ
The AASI printed in the table's PDF says the examiner must defer in its two cases. The FAA's separate AASI page for migraine headaches says the examiner should defer in the same two cases. Crosscheck shows both and does not decide between them.
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The AME must defer to the AMCD or Region if:
The Examiner should defer to the AMCD or Region if:
A first AASI application is deferred
The AASI says that if this is a first-time application for an AASI for this condition and the applicant has all the medical information needed for a determination, the examiner must defer and submit it all to the AMCD or RFS for the initial determination.
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If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the AME must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
Three statements for Block 60
The worksheet has the examiner note one of three statements in Block 60: CACI qualified (no documents go to the FAA); a current or previous SI/AASI but now CACI qualified; or not CACI qualified, deferred, with supporting documents submitted.
Show the FAA's words: good to know, 7
AME MUST NOTE in Block 60 one of the following: … CACI qualified migraine and chronic headaches. (Documents do not need to be submitted to the FAA.) … Has current OR previous SI/AASI but now CACI qualified migraine and chronic headaches. … NOT CACI qualified migraine and chronic headaches. I have deferred. (Submit supporting documents.)
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Open to print: CACI – Migraine and Chronic Headache Worksheet, a PDF at the FAA, in a new tab
- Migraine and Chronic HeadacheOpen to print: Migraine and Chronic Headache, a PDF at the FAA, in a new tab
Examiner can issue, Special Issuance, AASI
- Open at the FAA: AASI – Migraine Headaches, a page at the FAA, in a new tab
- Open at the FAA: Migraine Medication, a PDF at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Related conditions
Each has its own page, with what the FAA's documents say about it.
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.