16-year-old son having headache for 15 months

[Maria-H-Banker]

  My son began having headaches in Sept. 1997. It is now Dec. 1998. No one has been able
  to control them. He's been seeing a pediatric neurologist and has been on
  Esgic, Inderal, Cyproheptadine, Paxil, Prozac, Elavil, Excedrin, any other
  OTC drug you can think of, and he wakes up with them. He has missed so much
  school I doubt he'll pass this year (he's a junior and previously held a
  very high GPA). I don't know where to turn any more. He's had MRIs and MRAs,
  been to psychiatrists and psychologists. He won't talk to anyone, not even
  me. He will sit in his room all day, or sleep all day, then he can't sleep
  at night. No one will give him drugs to knock him out. He says he can't
  stand the pain any longer, but no one can figure out what his problem is.
  I typed a 3-page letter to another neurologist in hopes that I could brief
  her on his history as his present doctor has ordered me to get a second
  opinion before I bring my son back there. He tries new drugs, like every-
  one else, but the results don't last, it's like he gets immune to the drugs.
  15 months is a long time. They even x-rayed his sinuses and got nothing.
  He's clinically depressed now, I think he's a major depressive. How do you
  help somebody who won't talk? At wit's end. Also if you know of someone in
  the New Orleans area (we live 40 miles outside New Orleans) who is a
  headache specialist, please tell me. Life has been hell for 15 months.
Dear Maria:
Sorry to hear about your son.  Please, tell me alittle more about the headaches.  They sound daily, are they.  Does he have some headaches that are really bad and others that are less intense?  Are the really bad ones only several times a month?  Are there any other symptoms that go along with the headaches, such as sensitivity to light, sound, nausea, vomiting, and are they made better by going into a dark room and sleeping?  Do they have a pounding quality to them?  Where do they hurt, is it over the forehead or eyes?  Does he know when a really bad headache is coming on?  How high of a elavil dose was he one? and has he tried immetrix?  Has anyone tried to stop the headaches with either steroids or DHE?  Is he a good student, something like straight A's and involved in alot of activities?
What we found at the Cleveland Clinic is that there are teenager that have daily chronic headaches.  They may have started out with migraines, have a family history of migraines, and somewhere down the line they develop daily headaches.  These headaches are varying in intensity but never go away, there can be infrequent really bad headaches.  Multiple medications have been tried and nothing seems to work, the child is beginning to miss alot of school, but most of them seem to keep up.  What we tell our patients is several fold.  In our series of over 350 children with headaches like this, we use a TCA medication called Elavil.  We work the dose upwards until a serum level of 125 is reached.  We have both the parents and child visit a pediatric psychologist to assess secondary gain or other stressers in the childs life.  In our experience, we have found that there are three major stressors in a child's life that can produce daily, non-progressive headache (a term the our headache specialist coined).  These are stressors of family, school, or friends.  It takes both the medical treatment and psychological treatment (both family and child) to correct the headaches.  Our success rate is likely better than 75% in cure of those patients that stick to the program.  It takes many months to work.  There are a great deal of turmoil that occurs in the child and family.  But, in the end I think we have good success.
I am not sure of a pediatric headache specialist in your area.  Most importantly, not having diagnosed your child. let alone examined him put what I have said out on a limb.  The advice is what I would be doing given a particular exam and history.  Read and answer my questions and maybe this might be a help.  Best of luck, and please let us know if we can help.
Sincerely,
CCF Neuro[P] MD, RPS