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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: child diagnosed with abdominal migraine Hi, I have a 9 year old daughter who has had a myriad of health problems beginning with grade 4 kidney reflux at 2. She has a slight rotated bowel and asthma. She stopped growing recently for almsot two years and gaining weight and is just growing again now that she's off steroids and on accolade. She has always had migraine headaches but in the last year and a half she began having episodes of extremely high fever, 105 that are uncontrollable for days, and with this she has dilated pupils, headache, severe vertigo, feels like she is falling when moved, vomiting and dehydration. She has been hospitilized four times in a year and a half for dehydration and electrolytes out of sync and very slight liver changes in blood tests. It is always the same except for severity. Sometimes, she just has the fever, vertigo and confusion, sleep lots etc, no or very little vomiting, other times she has it all and will vomit for days. Never any diarehha or anything else. I was told at first she kept getting the flu! Other times like yesterday, she gets a fever, htis time only 38.5 (not sure of that in ferenheit) heart beating heart, flushed face eyes dilated slightly, head pain and stomach ache but no vomiting. Vertigo and nausea. Serious attacks are usually several months apart, small ones a few months apart. She also continues to have migrained but not as often since put on sandomigrain. I forgot she always has stomach pain with all this. I have done much reading on abdominal migraine and have yet to see anyone else say their child has such high fevers or lack of vomiting at times yet all else is constant. We have done a ct and it was normal it was done for a pituitary but the neurologist looked at it and said it was normal. If this is abdominal migraine that's fine but it is scary. Many tests have been done on my daughter because of all that's been wrong but an MRI has never been done. What I want to know, she is under the care of a pediatric neurologist by the way, is does this sound like abdominal migraine to you? The neurologist mentioned hormonal problems in the brain and tests she'd like to do if she's hospitilized again but that's not necessary this time and I feel we're being pushed to the back burner. Apparently the tests can only be done when she is sick. It's very frustrating for her, for us. It's just that while her symptoms seem to match, they don't in other ways and many doctors don't even believe in this condition, let alone acknowledge it. It is frustrating and scay and in CAnada so much is happening with out health care system, waiting lists etc that you wonder if the doctors really have time to look into things properly, not that I could afford your system. Should an MRI be done or other blood tests. CAn abdominal migrain present itself like this? Is it the same as cyclic vomiting? My neurology nurse says it is not. She is a highly intelligent child and is not suffering from any learning problems but does have a tremor and complains of muscles and joints alot. She does get tension headaches as well. Any information you can offer would be greatly appreciated. I thank you very much for your time and the offer of this service. Kerry Dear Kerry: Sorry to hear about your daughter. We have a small cohort of children who have abdominal migraine, and several that we have followed for 10 years or more. Except for the fever, the symptoms are very much like what we see in abdominal migraine. They usually are diagnosed by exclusion, in that we try and rule out other things that can give you similar symptoms. Epilepsy can mimic this picture, and is one of the diseases that we like to rule out. However, these patients vomiting would not last as long as your daughter, and I am sure epilepsy has been ruled out in your daughter. The fever is worrisome because the hypothalmus should theoretically not be involved in migraine, but in cluster type headaches. The symptoms sound very migrainous. I think that what your pediatric neurologist is doing is fine. We would do things alittle different based on our experience (and this may help answer the fever question). We would start a prophylaxic medication, elavil at bedtime. Start at 5-10 mg and elevate the I think if I saw your daughter here at the Cleveland clinic, I would order an MRI of her brain. The resolution of the MRI is so much better than CT, and I would want to be sure that there isn't a small tumor. I realize that things in Canada are different. However, if it were my daughter I would ask for one. I hope that the abdominal migraines resolve. Best of luck. Sincerely, CCF Neuro[P] MD, RPS |
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