Any Thoughts?

I have a 16 year old son who has had a migraine for the past 6 months.  His first migraine was at the age of 5, and his triggers after years of tracking were determined to be lack of sleep, not eating on a regular basis, and heat. His migraines were treated successfully with Maxalt until six months ago.

He does have MRI findings that are considered to be incidental to his migraines. They include a lesion in his thalamus which has remained stable for the 6 years we have known about it, and a Chiari Malformation which fluctuates in size...the first MRI revealed a 10mm herniation, other MRI's have shown no herniation and his most recent MRI shows 6.6mm herniation.  The Chiari was further evaluated and found to not be causing CSF flow obstruction.  All blood tests are normal.

When this headache he currently has was not relieved by the Maxalt, he was admitted to the hospital and received a "Cocktail" of various drugs, which did not resolve the headache. He was discharged 2 days later with a week supply of Tylenol 3, instructions to take Advil around the clock and follow up with a neurologist.  We live in an area that has limited specialists, so we decided to take him to a specialist about 2 hours away in a larger city...it took about a two weeks to get an appointment.

In the mean time, his pediatrician prescribed him a couple of different medications.  Tordol, Firocet, and Tylenol 3.  These were not taken at the same time, as one drug did not work, another one was prescribed.

When we got the the pediatric neurologist, she told us that his headache was medication induced.  We were instructed to stop all pain medications and he was started on Topamax.  We of course complied with this treatment, and in addition have taken him to relaxation therapy, acupressure,  biofeedback, and had him evaluated by a neuro optometrist (his pain is in his right eye)

The problem is, none of these measures have worked.  He has not been able to function for six months...he was unable to complete school last year, and with school starting right around the corner, it is looking doubtful that he will be able to attend unless this headache can be resolved.  

So my questions are:

Does a medication induced headache make sense?  While he took Maxalt for 10 years, I followed strict instructions about how much he could have to avoid a medication induced headache, and he has not had any Maxalt since the headache first started.  The other medications he was given, was only for a two week period, and he has not had them for the past 5 1/2 months.  Would a medication induced headache last this long?

Medications do not help the headache, and not giving him medication does not help the headache, where do I go form here?  He can not continue on this way....any suggestions?

[horselip]

To me that theory of "medication induced" sounds like a stab in the dark. Although medication induced headaches are a real issue, I think that the issue with you son is more related to what is happening with him medically aka anatomically.

The chiari malformation and the herniation seems to be a logical culprit and could cause a LOt of pain? Don't you think? And maybe migraine meds are not the right course of treatment for this? Some ideas that I might suggest are to get a consultation with a neurosurgeon about repairing the Chiari malformation. In the meantime, you might get your son into a good pain control center to get him some relief. He might need opiates? or at least a trial of them to see if they help. I am by no means a doctor, just a headache patient. I am getting very good relief from opiates right now. While I don't like that I have to take these I would rather have some function than be in bed all of the time.
So sorry that you are going through this....
Horselip