Travel Post-Stroke: Can I Fly?

Flying after experiencing a stroke is a common concern for survivors. While there is no formal medical guidance on how long to wait, medical research shows that flying after a stroke is possible, but certain factors should be considered. These include the type of stroke, the time elapsed since the stroke, and whether medical assistance is required during the flight. The Stroke Association recommends waiting for at least two weeks before flying, as the risk of a second stroke is elevated during this period. In some cases, patients may need to wait up to three months, especially if the stroke was severe. It is crucial to consult a doctor before flying to ensure safety and address any concerns.

How long after a stroke can I fly?

It's understandable that you may be concerned about flying after having a stroke. The good news is that, generally, a history of stroke does not pose a danger to the brain during air travel, and therefore, a past stroke is not a reason to avoid flying as a passenger. However, there are some important considerations and guidelines to keep in mind.

Firstly, it's worth noting that there is no formal medical guidance on how long you should wait after a stroke before flying. Most carriers advise not flying until 10 days after a Transient Ischaemic Attack (TIA) or "mini-stroke", 21 days after a stroke, or even three months if you have residual symptoms. If you've had a haemorrhagic stroke, which is caused by bleeding into the brain, it's usually recommended to wait six weeks. These guidelines are in place because you are at an increased risk of a second stroke after suffering a TIA or stroke, and it's important to be close to emergency medical interventions during this time.

In addition, new post-stroke medical conditions may arise within a few months of the initial stroke, so it's advisable to remain near your medical providers. If your travel plans are flexible, waiting one to three months to travel after a stroke is generally considered a good idea.

Before flying, it's crucial to consult your doctor, as they can determine if you are medically stable enough for air travel. They will take into account your individual risk factors and medical complications, and advise you accordingly.

It's also important to be aware of the potential risks associated with flying after a stroke. These include:

• Hypercoagulability (excessive blood clotting): Flying increases the tendency for blood to form clots, which can lead to ischemic stroke when an artery in the brain becomes blocked. Research shows that long flights can elevate clot risk by 26%. Deep vein thrombosis (DVT) can occur when a blood clot forms in the leg, and this can have life-threatening complications.
• Reduced oxygen levels: The lower air pressure on a plane means less oxygen is available to the body and brain. While this may not be an issue for stroke survivors, it can be a concern for those with comorbidities such as breathing difficulties or a heart condition.
• Delayed medical treatment: In the event of a stroke on a plane, an emergency landing may be required to access medical care. This can result in a delay in receiving appropriate treatment, which is time-sensitive in the case of interventions like tissue plasminogen activator (TPA) administration.

To summarise, while there is no definitive answer to how long you should wait after a stroke before flying, it's generally recommended to wait at least two weeks, and in some cases, up to three months. The decision should be made in consultation with your doctor, taking into account your individual circumstances and risk factors. It's also important to be aware of the potential risks associated with flying after a stroke and to take any necessary precautions.

What are the risks of flying after a stroke?

The risk of having another stroke is a concern for all survivors, and flying does increase this risk, especially in the first six months to a year after a stroke. However, it's important to note that the incidence of stroke while flying is low. Here are some of the risks to consider:

Hypercoagulability (Excessive Blood Clotting)

Flying increases the tendency for blood to form clots, and these clots are the cause of ischemic strokes, which occur when an artery in the brain becomes blocked by a blood clot. Research studies have found that long flights can elevate clot risk by 26%. Inactivity in cramped spaces on flights can lead to blood clots developing in the legs, known as deep vein thrombosis (DVT). Small pieces of this clot can break loose and travel to the lungs or brain, causing life-threatening conditions such as a pulmonary embolism or another stroke.

Reduced Oxygen Levels

The air pressure is lower on a plane, resulting in reduced oxygen levels in the bloodstream. While this may not pose a significant risk to stroke survivors, it can be an issue for those with comorbidities such as breathing difficulties or a heart condition.

Delayed Medical Treatment

In the event of a stroke on a plane, the pilot may attempt an emergency landing to access medical care. However, the time it takes to receive appropriate treatment may be prolonged, and some stroke interventions, such as tissue plasminogen activator (TPA), must be administered promptly.

Communication and Mobility Challenges

Stroke survivors may experience deficits in spatial perception, making it easier to get lost in an airport. Communication problems can lead to misunderstandings of flight information, and weakness and coordination issues can make it difficult to walk long distances. As a result, many stroke survivors may require a companion or professional assistance when travelling.

Other Considerations

The general advice is to avoid flying until you can walk 50 metres without getting breathless or climb a flight of stairs without getting breathless. Additionally, seating for long periods during a flight can increase the risk of developing clots in the leg veins (DVT), especially if you have mobility issues after your stroke. It is recommended to book extra legroom, stay well-hydrated, avoid alcohol, and move your legs and feet as often as possible during the flight.

Airline Guidelines

Most airlines advise waiting at least 10 days to three months after a stroke before flying, depending on the severity and any residual symptoms. If you have had a haemorrhagic stroke, caused by bleeding into the brain, it is usually recommended to wait six weeks. It is crucial to consult with your doctor and get medical clearance before flying to ensure your safety.

What precautions should I take when flying after a stroke?

Flying after a stroke is a common concern for many stroke survivors. The good news is that, according to medical research, a history of stroke does not pose a danger to the brain during air travel, and a past stroke is not a contraindication to flying as a passenger. However, there are still some important precautions you should take to ensure a safe and stress-free journey. Here are some guidelines and tips to help you prepare for your trip:

• Get medical clearance: Before planning your trip, consult your doctor to ensure that you are fit to travel. Every stroke is different, and your doctor can determine if you are medically stable enough for air travel. It is also important to discuss any other medical conditions or complications that may affect your health during the flight.
• Wait at least two weeks: According to the Stroke Association, it is recommended to wait for at least two weeks before flying after a stroke. This is because the risk of a second stroke is higher during this period. Some airlines and medical guidelines advise waiting for a longer period, ranging from 10 days to three months.
• Arrange special assistance: Contact your airline in advance (72 hours to one week) to arrange any necessary assistance, such as vision or hearing assistance, wheelchair service, or help with mobility and medical device transport. Airports also have assistance points where you can request transportation assistance if needed.
• Travel with a companion: Consider travelling with a companion or professional assistant, especially if you have mobility issues or communication difficulties. This can provide peace of mind and help you navigate the airport and in-flight experience more easily.
• Get travel insurance: Ensure that you have adequate travel insurance that covers your specific needs, including any pre-existing medical conditions. Travel insurance will protect your trip and provide coverage for any unexpected medical costs or emergencies abroad.
• Allow extra time at the airport: Give yourself plenty of time to get through security and reach your gate without rushing. This will help reduce stress and allow for rest during your travel itinerary.
• Keep medication accessible: Always carry your medication in your hand luggage and ensure you have enough for your entire trip. Keep medical documentation with you and declare your medication upon arrival at your destination.
• Wear compression socks: Compression socks improve circulation in your legs and help prevent blood clots from forming during the flight. Choose knee-high compression socks with a compression level of 20-30mmHg for the best results.
• Stay active during the flight: Move around the cabin when possible to prevent blood clotting. If you cannot walk, perform leg exercises while seated, such as marching in place or pumping your ankles.
• Monitor your diet: Be mindful of your food and water intake, as this can affect your blood pressure. Stay hydrated and avoid excessive salty snacks to maintain stable blood pressure levels.
• Book extra legroom: Consider booking extra legroom seats in advance to make your flight more comfortable and allow for easier movement during the journey.
• Avoid alcohol: Alcohol can cause dehydration and increase the risk of clot formation. Instead, focus on staying hydrated by drinking plenty of water during the flight.
• Keep yourself occupied: Flying can be stressful, so bring along items to keep yourself occupied and relaxed during the flight, such as books, music, or other in-flight entertainment options.
• Inform your travel companions: If you are travelling with family or friends, ensure they are aware of your condition and any potential risks or complications that may arise during the trip. This will help them provide better support and assistance if needed.

By following these precautions and planning ahead, you can ensure a safer and more enjoyable travel experience after a stroke. Remember to always consult your doctor and follow their advice regarding your specific situation.

What travel insurance should I get after a stroke?

If you've had a stroke, it's important to get the right travel insurance to ensure you're covered for any medical emergencies related to your condition while abroad. Here are some things to consider when choosing a travel insurance policy:

• Medical Emergencies: Look for a policy that provides unlimited or high-limit cover for emergency medical expenses. This will give you peace of mind knowing that you're covered for any unexpected medical costs, including prescription medication and medical equipment.
• Pre-existing Conditions: Make sure to declare any pre-existing medical conditions, including your stroke, when taking out a policy. Failure to disclose pre-existing conditions may affect the validity of your policy if you need to make a claim. Be as honest as possible about your medical history to ensure you're comprehensively covered.
• Cancellation and Curtailment: Choose a policy that covers flight and accommodation costs if you need to cancel or cut your trip short due to medical reasons. This will protect you financially if you have to return home early due to a medical emergency.
• Baggage: Opt for a policy that provides protection against the cost of stolen, damaged, or lost luggage and personal possessions. This is especially important if you need to carry valuable items such as medical equipment or medication.
• Travel Delays and Missed Departures: Select a policy that compensates you for flight delays and covers accommodation and transport costs if you miss your flight. This can help reduce financial stress in case of unexpected delays or cancellations.
• Personal Liability: Consider a policy that covers legal expenses and any liability if you accidentally injure someone or damage their property while on holiday.
• Age and Destination: Some travel insurance policies have age limits or restrictions on destinations. Look for a policy that covers all ages and destinations to ensure you're covered regardless of your age or chosen travel destination.
• Specialist Providers: Consider using a specialist medical travel insurance provider if you have multiple pre-existing conditions or specific needs. These providers can tailor their policies to your specific requirements, giving you peace of mind while travelling.

Remember to shop around and compare policies from different providers to find the best coverage for your needs. It's also essential to consult your doctor before travelling to ensure you're fit to fly and to understand any specific health requirements you may have during your trip.

What airport assistance is available for stroke survivors?

Airports can be challenging places to navigate, especially for stroke survivors with mobility, sensory, or cognitive difficulties. However, airport assistance is available to make travelling easier for stroke survivors. Here are some of the services offered:

Accessible Facilities and Trained Staff

Most airports have accessible facilities and trained staff who can assist stroke survivors from their arrival at the airport to boarding the plane. This includes help with navigating through the airport, checking in, and getting through security. Some airports also offer wheelchair assistance, both within the airport and on board the aircraft. It is important to book the right type of assistance in advance, as different options are available depending on your needs.

Priority Services

When you book airport assistance, you and your travelling companions are often given priority during check-in, security checks, and boarding. This can help reduce stress and make the airport experience more comfortable.

Continuous Support

The assistance provided at airports is not limited to just one aspect of the journey. The same staff member who assists you at the airport will usually stay with you until you board the plane. Similarly, upon arrival at your destination, assistance will be available to help you through the airport and its formalities until you reach your onward transport.

Special Services for Non-Physical Disabilities

While most airport assistance guidelines focus on mobility issues, some airports are recognising the need to support travellers with non-physical disabilities. For example, Manchester Airport in the UK has implemented a scheme that fast-tracks children with autism through security, providing them with a booklet and video guide specific to each terminal. This type of initiative can be beneficial for stroke survivors who struggle with communication, processing information, or background noise.

Travel Insurance and Medical Clearance

In addition to airport assistance, it is essential to have comprehensive travel insurance that covers any unexpected medical emergencies. Before travelling, it is also recommended to visit your doctor to obtain a fit-to-fly certificate and ensure you have enough medication for your trip. If you have had a recent stroke, some airlines may require you to complete a Medical Information Form (MEDIF) and obtain medical clearance before flying.

Frequently asked questions