Continuous migraine aura in 14-year-old daughter

[Leahesther]

My 14-y.o. daughter has had continuous migraine aura (without headache) since December. It began following a bad reaction to Paxil; after 6 days at 12.5 mg, she experienced full-blown hallucinations. She describes her current symptoms as seeing millions of layers of shimmering white lights all the time, including in the dark, w/ eyes shut, & in her dreams. She has other visual disturbances: colored lights, trails following objects, after-images, distorted peripheral vision, stationary objects moving. She had a normal MRI, eeg, and eye exam (with the exception of an unusual color deficiency). Along with her visual disturbances, she has dizziness, chills, sleep disturbances, and fatigue. In January, she was diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS). However, her electrophysiologist expressed concern that she had a number of overlapping migraine symptoms. We saw a pediatric neurologist whose only recommendations were eliminating migraine triggers and improving sleep hygiene. We are very concerned that we are losing time in figuring out what is causing her visual problems and treating them.

Several years ago, you responded to a 38 y.o. woman with similar symptoms by saying the Cleveland Clinic treats such conditions aggressively, with IV meds. Has this approach been successful? Would you treat a 14-year-old similarly? Is there a particular doctor at the Cleveland Clinic that would be best to see given her symptoms? Do you know of any clinics in the Washington-Baltimore area that take an aggressive approach to treating this type of problem?

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

By usual definitions, migraine auras will not occur for more than 60 minutes, especially if not followed by a headache

Migraine without headache is much less common than migraine with headache, but typically occurs in the older age group

Therefore I would make sure that another cause is excluded before calling this migraine (which it may well be, it just has to be a diagnosis of exclusion)

It would be useful to capture one of these episodes on the EEG - the EEG can be normal in between episodes, to exclude seizures (one can also see changes associated with migraine on the EEG sometimes too, during an event)

I was not answering these questions several years ago, and do not have that particular question on hand, so I am not sure what particular treatment you are referring to.
Migraine can be treated successfully with IV medications such as dihydroergotamine (DHE) or valproic acid

Our pediatric headache specialist is Dr. A. David Rothner, who has an enormous amount of experience with diagnosing and treating pediatric headache and migraine.

[Leahesther]

Thank you for your response. Maybe I wasn't clear enough that my daughter experiences these visual disturbances 24/7. There is no "episodic" nature to them. I also thought it might be helpful to include the link to the earlier question/response from the CC to the 38 y.o. woman I mentioned with similar symptoms: www.medhelp.org/forums/ne...1637a.htm

There are a lot of people out there with 24/7 visual disturbances that their doctors have been unable or unwilling to treat. If the Cleveland Clinic has been successful at treating these, that would be of great interest to those of us who are suffering or watching family members suffer.

Thanks.