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Q&A: Post-concussion Syndrome

Source:, By Penny Giovanetti, D.O. Manager, Aerospace Medical Specialties Division

Q. I was in an automobile accident a year ago. I was rear-ended by a 23 yr. old texting and driving 75 mph; I was nearly stopped. I lost consciousness for about 15-20 minutes. Since then, I suffer from occasional migraines induced by fluorescent lights, computer screens and excessively noisy environments. Knowing my triggers, I’m usually able to avoid situations that will bring on a migraine, but not always.

My memory loss, irritability, inability to concentrate, appetite, frequency of my headaches and my quality of sleep are vastly improved since the accident. I am taking Cymbalta (60mg/day), Flexoril (10 mg as needed) and MaxAlt (as needed). I feel as if I’m doing much better and on my way to complete recovery; which my neurologist has predicted.

I’ve been told not to see my AME until I’m fully healed. Knowing I may only have one chance at my Class I, I want to get it right. At what point should I see my AME so I can get my Class I without restrictions? Should I be off all medications? How long needs to pass since my last migraine? Will they need copies of CT scans, EEGs and MRIs? Or can my neurologist write a historical medical summary? What type of documentation will I need to provide? Thanks for your insight.

A. First of all, glad to hear that you are improving. Post-concussion syndromes can be very unpredictable. Your persistent migraines may be an issue depending upon their character and frequency. Based on your duration of loss of consciousness alone, your injury would be classified as mild and the minimum wait time is six months. But there are a variety of factors which must also be considered, such as your clinical status at the time of the injury and the results of your imaging studies. Cymbalta is a disqualifying medication, so you would need to be off that one. Flexeril may be taken on an intermittent basis with an eight day no-fly waiting period after use. Maxalt has a 24 hour no fly period after use. We would need all the documentation from the initial injury and current status from your treating physician. When you do go to your AME, it would be helpful to take all the records with you. After reviewing them, he or she should be able to advise you on what further documentation might be needed and whether the time is right to return to flying.

Penny Giovanetti, D.O., received a bachelor’s degree from Stanford, a master’s in Environmental Health and Preventive Medicine from the University of Iowa and a doctorate from Des Moines University. She completed a 27-year career as an Air Force flight surgeon. She is board certified in aerospace medicine, occupational medicine, and physicalmedicine/rehabilitation. She is also a Fellow of the Aerospace Medical Association and a private pilot.

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