Boarding an airplane is associated with a number of risks. During a flight, the cabin pressure is less than on the ground and is about the same as if you were 2000m above sea level. This means there is slightly less oxygen in the blood. It also means any air inside the body will expand. This is the reason for eardrums ‘popping’ when a plane takes off or lands – there is air behind the eardrum. Also, cabin air is dry with about 10% water humidity compared to 50% in an average building. This can dry out the skin and the eyes (for example, with contact lenses). There is less space to move around in, especially in economy class, and sitting still can lead to blood clots. These clots usually happen in the legs (deep vein thrombosis) but could happen anywhere including in the head. Finally, of course, no ambulance or hospital can help you on a flight.
The International Air Transport Association has made specific guidelines for people with neurological conditions about when they can fly. I have summarised them in this table but they can be seen in the IATA Medical Manual too.
| Disease | When can you travel? |
| Brain surgery | After 10 days from the operation if no air inside the skull |
| Dementia | Mild dementia with no aggression, paranoia and able to do daily activities |
| Epilepsy | After more than 24 hours after a tonic-clonic seizure |
| Stroke | After 2 weeks if stable. After 5 days allowed with a nurse escort and oxygen |
| TIA | After 2 days if investigated and well |
For other conditions and outside of these criteria, a review by an aviation medicine specialist may be requested. The final decision is made by the airline.
If you have a neurological condition that you would like to discuss, then please get in touch with us.