For pilots with migraine, every prescription must be filtered through certification rules, no-fly windows, and operational safety, not just headache efficacy, because the wrong drug choice can immediately affect flight status.

FAA approval requires migraine stability, low event burden, and acceptable medications; Some preventives remain acceptable, but tricyclics and antiseizure drugs are disqualifying; Botox and CGRP injectables may be allowed only with defined no-fly windows; Most triptans require at least a twenty-four-hour no-fly interval; Rescue therapies with sedation or impairment risk are incompatible with flight status