12 year old boy, migraine for 9 days now, Need HELP!

[sonhurting]

My son has a 1 year history of migraines.

This one started as a sinus type headache Jan.3, 2009, took motrin as directed by MD & Neurologist.
Next day it evolved in full blown pain level 10 migraine. Used Migrainal & Zofran. Repeated next day as directed, no help.
*On Tuesday (day 3) went in for IV drugs. He was given Bendryal, Zofran, DHE-45, torodol: No help at all, DHE-45 made headache worse.

*On Wednesday (day4) again iv meds: was given Bendryal, Zofran, magesium and torodol (iv push): No help again, not worse. Also gave him 50mg of Seroquel to sleep.

*On THursday (day 5) iv meds again: Zofran, Depacon, steriods, Torodol (iv push): No help, not sorse but not all any better. All of these drugs were iv fusion. Also gave hime 50mg of Seroquel to sleep.

*Friday (Day 6) Called neurologist, went in ER was given: Torodol & rofran: Nothing no help. THen was given 4mg morphine: caused chest pain, then sudden sharp pains at base of skull, you coudl not even tell this child has taken this major pain killer. Later that evening, the admitted him to get small amounts of DHE-45 over a few days. He got DHE-45, zofran, started Topomax 25 mg 2 times a day, steriods, seroquel to help sleep. No help from anything.

*Saturday (Day 7) in hospital he got EKG, labs done. ( Had MRI & Cat scan in 10/08, with remarkable results) He was given: DHE-45, (had to stop, due to making head worse again), steriods, zofran, Topomax in creased to 25mg in am, 50mg in pm. My son started crying at everything and also seem to be having panic attacks. No of this treatment helped either.

*Sunday (day 8) Dr decided that nothing was working, he needed to go home on Topomax and jsut let the migraine burn itself out. Also took Kolopin for panic attacks, seroquel that night. Which yeilded, no stop crying....

*Monday (Day 9) My son is still in severe pain, on a 1-10 scale he says it is a 15. He is and has been senstive to light, sounds. THis has been extreme this time. His heart rate has been running 110-113 during all of this, with slight high BP. He took his Topomax this morning and his heart rate is now 131, which is driving him crazy.

My question is : Is there a PAIN medication out there that may end this PAIN? I am concerned about the Topomax and that it needs to be stopped and restarted after this event, so his heart will not be more overworked. This is the WORST migraine, most pain, longest time for him yet. He can NOT handle and more pain, he thinks his head is going to exploid. Is there anything that can help him?
More History:
Tried Imtrex (no help), Midrin (uncontrolled crying), Maxalt (ER visit, extreme high BP), Frova ( no help)
Can not take: Adivan, phenagran. Nervous system reaction with both.
He also has Asthma, take Zertec, Singulair daily. Asthma meds as needed, have not used in almost 8 months.

[tomsant]

So the current situation is a continuation from 19 Dec.

Since your doctor watched him panic, (he has concluded the panic is unusual, and can be taken as an unbiased observation; as for you it is difficult to think with detachment) and has suggested pysch consultation, do that. Especially so since the headache 'very severe', this long, and bilateral.

I can't think of any medicine, usually given for laryngitis, to cause this.

Hope you can appreciate the difficulty of commenting without seeing the patient. Lt us know what the psychiatrist/psychologist feels.

Best rgds,

TA

[sonhurting]

viral laryngitis was 12/19/08, 14 days of meds, which put him at 1/2/09. This migraine hit 1/3/09, it hit different than others.

Start mild with pain in the middle of forhead and all over (normally pain starts in both temples and stays there the entire time, which is usually 5 days, no less)
This one moved from middle and all over to temples by the next morning. 1/4/09.
It has stayed in temples and now on Day 11 is has not gotten any better.

Neruo says- see a psys. to see if there is underlying cause there. (he paniced in hospital after being given morphine, that casued chest pains and sharp pains in the base of skull) My god he is 12, most kids would panic...  sorry venting..

sinus x-ray Nov 07 when migraines first started.
CAT Scan 1/08 to make sure there was no mass. (to rule it out)
MRI was 11/08 when put in hospital for another migraine.
**Not sure if these included nose, I think CAT scan was of brain, and MRI showed the whole head from the neck up from what I saw**

This one has been going on for 11 days now. I am thinking about taking him to Duke Hospital in Durham NC. Best closes one..


I did start him back on Rhinocort Aqua nasal spray last night.

Kinda wondering if the just getting on meds for larygnitis has anything to do with this....

Thanks!

[tomsant]

Incidence of viral laryngitis and it turning bact laryngitis is nothing unusual. (Hope this was some time back) Many go around with it without knowing what it is.

But why did he have the Xray PNS, and the CT in November (or is it 11 Aug?) and MRI (11th of Sept?) All for this headache?

Was this CT / MRI specific for brain? Or did they include nose and paranasal sinuses?

Anyway, start the Rhinocort Aqua nasal spray.

Yeah, I would suggest an ENT evaluation.

(And I wish the ENT would be 'interested' in headaches ;-)

Hope you will get back to us to tell what he/she found in the nose.

Best rgds,



TA

[sonhurting]

1.My son did just get over viral laryngitis that turned to bacterial laryngitis. He was treat with a Ceftin type drug for 14 days. He also to 60mg of steriod for 3 days, could not talk for 9 days. During this he was checked by an ENT.

Yes, he has only been seen by Neuro.

He had a sinus xray last year and a CAT Scan, 11-08. All were clear. He had an MRI in 11-09 when hospitalized for migraine, we went in level 8, left at level 6 apin level. That time torodol iv push worked.
We have Rhinocort Aqua 32mcg, not sure if it strong enough, I am starting him back on it now, just in case.
So would you recommend an ENT that is actual looking for something like that?

Thanks!!

2. No accidents

[tomsant]

Sorry that your son is continuing to have headache in spite of treatment. It is very difficult to comment without seeing him. But I will add my thoughts:-

1. He is a known asthmatic and I would stretch my imagination to assume he has allergic rhinitis and may be polyps in his nose/ sinuses. And may be a deviation of nasal septum? Some peculiar combination of such conditions can produce similar headaches. I would have examined his nose and may be start nasal topical steroid spray. Also try the effect of local anaesthetic Xylocaine /Lidocaine in the nose, either as drops or inserting cotton tipped probe dipped in the medication to selected areas of the nose. (The only specialist who has seen your son is neuro?)

2. I also would consider a cervicogenic headache here. (Disorders in the neck vertebral column etc causing headache) Usually there is a previous episode of whiplash injury to the neck., like a jolt if getting involved in a traffic accident. See if keeping the head and neck in some relaxed position helps.

Hope this helps. Wish Godspeed in his cure.

Best,

Thomas Antony

[DrNoopurMD]

Hi,

I can understand your frustration and what your young son is going through. I would suggest you to discuss Biofeedback therapy with his doctor.
Also in refractory migraine or in status migrainosus, Droperidol is known to provide good relief.
http://www3.interscience.wiley.com/journal/119166765/abstract?CRETRY=1&SRETRY=0

You can also discuss this option. In some cases steroids are also used. Meanwhile make him lie in a quiet dark room and keep applying ice packs to his head and neck.
Good luck!