Chronic Daily Headache with Migraine

[SteveH]

Dear Sirs, We have a 15-1/2 year old daughter who has now had a continuous migraine since Feb 22, 2003. She is light sensitive and sound sensitive, and when she gets too much of either, her headache gets worse and then she becomes nauseated and dizzy. Her headache is 24/7, never below an 8 on her pain scale, and goes up to a 10, 2 to 3 times a month. We have to home school her to control her environment. She has been treated at the Diamond Headache clinic, inpatient unit for 3 weeks, and 1.5 years as an out patient. After 36 different medicines, not one moved, budged, or lowered her headache. Typically the medicines only made it worse, especially when she took any SSRI's. She is currently on no medicines. Her younger sister who is 11, was recently placed on Zoloft to try and treat some OCD behaviors. When she hit 75 mg, she complained of a constant headache. Even 6 weeks off, the medicine, she still had a headache. She has not been off it for 12 weeks and her daily headache is gone. Thank God. My question is "Can too much Serotonin cause chronic daily headache?" I tried researching this but found nothing. Is there a drug that reduces serotonin?

[CCF-Neuro-M.D.-PW]

There is a syndrome of serotonin toxicity called serotonin syndrome, usually seen with interaction between medications that promote the serotonin system. Isolated headache though is not a feature of the syndrome - it usually causes confusion, euphoria, muscle spasms etc. SSRI are probably not the primary cause of her headache

THere is no drug that reduces serotonin in the same way that SSRIs increase it over time. Some of the triptan migraine medications are serotonin antaganists at various different types of drug receptors, but are only used in teh acute rather than chronic setting.

Medications alone are usually not enough to break these headaches. One must be on a multidisciplinary program involving headache psychology, physical therapy for the neck (a common trigger of headache), medications, biofeedback, trigger point injections etc. Perhaps a second opinion at another headache center with all of these facets of treatment would help.

Goodluck

[Citizen T]

I would presume she's had an MRI brain scan?   You may also want to look into an MRA scan to rule out aneurysm, and MR venogram to rule out venous sinus compression.  Neck imaging may also be warranted.  A Lyme disease titer and eye exam wouldn't hurt either.

[heart2heart]

Yes, she should have an MRA done to rule out vascular issues, although some things like brain vasculitis can only be proven with a brain biopsy...which should be the ultimate last resort. Has she had any autoimmune tests...like sed rate and test for Lupus?

[Citizen T]

MRI is usually sensitive to CNS vasculitis.  Although, it would be abnormal, it wouldn't be certain if it actually WAS vasculitis without the biopsy

[SteveH]

Yes, she has had an MRI and an MRA of the head, plus a CT of the sinuses, and 3 eye exams. We have not looked into Lyme's desease yet or this brain vasculitis. Also looked into Chiari Malformation but I do not believe the local Nuerologist looked to hard and we never discussed that with the Diamond Headache Clinic.

Anyone know why using an SSRI would increase the headache in her as well as cause a headache in her sister?

[heart2heart]

Look up the SSRI she was given. Chances are headache is one of the side effects listed. It could be a side effect of the drug. They all have side effects. I was on Zoloft and had daily hot flashes and dry mouth. Perhaps it raised her blood pressure? There are a lot of possibilities here.
BTW, did your daughter's doctor mention the possibility of pseudotumor cerebri? It usually is found in young women (usually who are overweight) and can manifest with headaches and vision problems.

[beckd]

During the past 7 months, I have had constant headaches.  I have never had more than the occasional headache treatable with ibuprofen.  I have currently been to a neurologist that has put me on a course of steroids and bellergal s to "break the  migraine cycle."  No migraine medication works--Leading me to believe these are not migraines especially since there is not history in myself or my family.  The next option is hospitalization with IV ergotamines (DHE).  They did find a 2mm pineal cyst -- clear fluid filled and a 3cm x 2cm right maxillary mucous retention cyst.  I have been told there is absolutely NO relation to cysts and headaches.  Due to the fact, that no medication works...especially the migraine meds...is the statement "absolutely NO relation" accurate.  Thank you for any help.  And...is there any neurologist in the Dallas/Ft Worth, Texas area that you would recommend.