Question Title: Correlation between head trauma, migraines and focal point seizures

My daughter's history is as follows:

10/96 - My 6 year old daughter hit her head on a wooden dresser while jumping on the bed. A trip to the emergency room resulted in 8 stitches in the middle of her forehead. She was somewhat lethargic and dizzy which the E.R. doctor attributed to hitting her head and was not concerned of any underlying injury.

Shortly thereafter (within a month) she started complaining of headaches beginning behind her right eye and radiating backwards. These headaches left her physically exhausted, very lethargic, pale and weak. They have made her vomit and three times in the last two years they have woken her up from a sound sleep. A trip to the pediatrician at the onset of these headaches left her with a diagnosis of "migraine" headaches. Advil to control pain. She can tell they are coming because she gets slightly dizzy and "slight needles and pins" around her eye and lips. These headaches usually come on in the late afternoon or early evening, however they have occasionally occured mid morning. They were frequent early on, occuring 2 - 3 times per week but now they have lessened to 2 - 3 times per six months. However, they also tend to "cluster" where she will get several in a short period, then not again for several months. A food and stress level diary have indicated nothing.

Last year, she began having concentration problems at school. This year, her grades are falling behind and she is having extreme concentraton problems. Her reading skill is far below her grade level, however her math skills are well advanced. She also cannot seem to be able to develop a working relationship with her teacher, who has indicated that she feels testing for ADD might be a good idea.

A trip to a new family doctor has indicated that there may be a link to the migraines and "focal point seizures" and we are now waiting to get into the pediatric neurologist (a three month waiting list) for testing. It's been explained that during a "seizure" the brain acts like someone turned a light switch off for a moment and the loss and distruption of information received by the brain may be causing the learning and behavior problems. The doctor also has indicated that several of these "seizures" in a short time period may trigger the migraine headaches. My daughter does tend to drift away at times and must be repeatedly called or gently shook before she will respond. Waiving a hand in front of her face does nothing to get her to respond (and I was angry because I just thought she was ignoring me.)

Since the wait to get into the neurologist is so long, I would appreciate any information on the possibility of these problems being linked together, since the onset of all of them seemed to be the same time as when she hit her head. We have a family history of "food" triggered migraines on the maternal side, and "cluster" migraines on the paternal side. There is no family history of any type of epilepsy or seizure disorder. What tests can I expect to be performed to diagnose the cause of these problems? What is the likely prescribed treatment to control her symptoms? Will the neurologist be able to offer any insight or remedies for the learning and behavior problems we are now experiencing? Any information received will be greatly appreciated.

Dear Mr. Gallo:

Sorry to hear about your daughter. It is impossible to tell you that it is or isn't all related without examining her, seeing the brain scans, the blood work etc. My feeling is that the trauma is not related to the headaches, inattention, or possible seizure disorder. The family history of migraines makes me think that the headaches are migraines. The type of headache described fits the migrainous picture. And no, advil is not the medication for this. The inattention can be Attention deficit or it might be seizures. The most likely type of seizure is absence. A couple of questions that if you answer yes to would heighten the diagnosis for absence seizures (but not confirm the diagnosis, an EEG is needed for that): 1) does she become unresponsive at play or at something she really enjoys doing 2) does she not respond to you when you physically stimulate her with touch, 3: do you notice whether she will become inattentive while she is in a middle of a sentence and just stop talking to you or friends and 4: do you see any eye blinking, hand movement or lip smacking. The visit to the pediatric neurologist will solve the issue of absence seizures. My best guess is that your daughter suffers from migraine headaches and attention deficit. Again, without doing the physical exam and seeing the tests it is impossible to tell. It might be good to have letters from the teachers explaining what they see in you daughter at school for the pediatric neurologist.

Best of luck.

Sincerely,

CCF Neuro[P] MD