Migraine headaches affect millions of people, including many pilots. The good news is that the FAA has streamlined the certification process for pilots with well-controlled migraines through the CACI (Conditions AMEs Can Issue) program. This guide explains everything you need to know about maintaining your medical certificate while managing migraines.
Understanding the CACI Program for Migraines
The FAA's CACI program allows Aviation Medical Examiners (AMEs) to issue medical certificates on the spot—without FAA headquarters review—if you meet specific criteria. This applies to several types of headaches:
- Classic/common migraine
- Tension headaches
- Cluster headaches
- Chronic daily headaches
CACI Eligibility Requirements
To qualify for CACI certification, you must meet ALL of the following criteria:
- Headaches occur no more than once per month
- No more than 2 exacerbations in the past year
- No in-patient hospitalizations for headaches
- No TIA-type symptoms, vertigo, or mental status changes
- Condition documented as stable by your treating physician
- No use of injectable or narcotic medications
Required Documentation
Your AME must review a detailed clinical progress note from your treating physician generated within 90 days of your FAA medical exam. The note should address all CACI criteria.
Reporting frequency:
- 1st/2nd class certificates: Annual clinical progress note required
- 3rd class certificates: Progress note required with each FAA exam
Download the official CACI Migraine and Chronic Headache Worksheet and share it with your treating physician before your appointment to ensure all required information is captured.
Approved Migraine Medications
The FAA has specific guidelines for migraine medications, divided into prophylactic (preventive) and abortive (acute treatment) categories.
Prophylactic (Preventive) Medications - CACI Acceptable
These medications are taken regularly to prevent migraines. All require a 7-day ground trial before flying:
| Medication Class | Examples | No-Fly Time |
|---|---|---|
| Beta-Blockers | Metoprolol (Toprol XL), Propranolol (Inderal) | None (after 7-day ground trial) |
| Calcium Channel Blockers | Verapamil (Calan), Nifedipine (Procardia) | None (after 7-day ground trial) |
| ACE Inhibitors | Lisinopril (Prinivil, Zestril) | None (after 7-day ground trial) |
| CGRP Antagonists | Aimovig, Ajovy, Emgality, Qulipta, Vyepti | None (after 7-day ground trial) |
Abortive (Acute) Medications - No-Fly Periods Required
These medications are used to stop a migraine in progress. Each dose requires a waiting period before flying:
| Medication | No-Fly Period After Each Dose |
|---|---|
| Triptans (Imitrex, Maxalt, Amerge, Axert, Zomig) | 24 hours |
| Triptans - longer half-life (Relpax, Frova) | 48 hours |
| CGRP Antagonists (Nurtec, Ubrelvy, Zavzpret) | 48 hours |
| Ergot Derivatives (Migranal) | 48 hours |
| Reglan (metoclopramide) | 36 hours |
| Zofran (ondansetron) | 24 hours |
| Phenergan (promethazine) | 96 hours |
| Tylenol, Ibuprofen (OTC) | None |
Disqualifying Medications
The following medications are NOT acceptable for FAA medical certification:
- Topiramate (Topamax)
- Gabapentin (Neurontin)
- Pregabalin (Lyrica)
- Tricyclic antidepressants (all)
- Valproic acid (Depakote)
- Lamotrigine (Lamictal)
- Narcotic analgesics
When Special Issuance is Required
If you don't meet CACI criteria, you'll need a Special Issuance Authorization from the FAA. This may apply if you have:
- Complicated migraines with neurological symptoms
- Ocular or retinal migraines
- More frequent episodes than CACI allows
- Required hospitalization for headaches
For Special Issuance, the FAA typically requires:
- Detailed clinical progress note from a board-certified neurologist
- MRI of the brain (within 1 year of AME exam)
- Statement on monthly headache frequency
- Complete medication details with side effects documentation
Tips for Pilots with Migraines
- Know your triggers - Common aviation-related triggers include altitude changes, dehydration, irregular sleep, and cockpit lighting
- Stay hydrated - Dehydration is a major migraine trigger in the cockpit
- Plan medication timing - Know your no-fly periods and plan flights accordingly
- Don't self-diagnose on your MedXPress - Avoid casually labeling occasional headaches as "migraines" on FAA Form 8500-8, as this triggers additional certification requirements
- Keep documentation current - Ensure your physician's progress notes are within the 90-day window
Official FAA Resources
- FAA Migraine Medication Guide - Complete list of approved medications and no-fly times
- CACI Migraine Worksheet - Share with your treating physician
- FAA Headache/Migraine Policy - Official AME Guide reference
Need Help with Your Medical Certificate?
If you have migraines and are unsure whether you qualify for CACI or need Special Issuance, Go Flight Medicine can help guide you through the process. Our experienced HIMS AME team understands the FAA requirements and can help ensure you have the proper documentation for a smooth certification process.
Last updated: January 2026. Always verify current FAA policies as guidelines may change.