Headaches and More in Child

Hi
Over the past year my daughter has begun to have almost daily headaches, sometimes severe and sometimes more of just a continuous, less severe headache.  She is 9.  She has been on topamax, cyproheptadine, propanolol and amitryptaline at different times with no relief.  Pain relievers also do not seem to help her very much at all.  About six months ago she began experiencing visual aura-symptoms that sometimes last continuously for several weeks at a time (sudden blurred vision, loss of peripheral vision and moving colored dots and lines in her vision).  She experiences this even when a headache is not present.

Intermittently she has been having severe burning pains in different parts of her body (mostly on the left side), muscle spasms in her feet and one time her back.  Her left eye also sometimes just closes for a few hours or days at a time and she can't open it.  She also may have suffered a couple partial seizure episodes over the past year but only I witnessed them so I'm not sure her doctors believe that it really happened.  

In the past she had a subdural hematoma from a fall she suffered at age 4.  She also used to have absence seizures which started at age 3 but stopped about the age of 6.  She was exposed to drug use in the womb from her birth mother

An EEG and MRI of her brain (without contrast) were both normal except they noted in her MRI that she had some old brain damage that might have been from a prenatal stroke.  .

The pediatric neurologist says she only has migraines and that seizures can definitively ruled out from the EEG.  He said an MRI will always show any other abnormality in her brain and that she doesn't need any other tests. None of the migraine medicines help her and I am concerned about these other symptoms which her doctors seem to discount (eye dr, family dr, neurologist)

Is there further testing that might be warranted in a case like hers?

Thanks

[Shazia Alam, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from your daughter and examine her, I cannot comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter. Her clinical history and symptoms may be suggestive of a condition called Hemicrania continua.  This is usually a primary headache, which essentially means it is not caused by something else.  In order to diagnose Hemicrania Continua, there needs to be a headache for more than 3 months fulfilling three other conditions:
1. All of the following characteristics:
o Unilateral pain without side-shift
o Daily and continuous, without pain-free periods
o Moderate intensity, but with exacerbations of severe pain
2. At least one of the following autonomic features occurs during exacerbations and ipsilateral to the side of pain:
o Conjunctival injection and/or lacrimation
o Nasal congestion and/or rhinorrhea
o Ptosis and/or miosis
3. a Complete response to therapeutic doses of indomethacin (medication).  Usually a doctor will prescribe this as a trial for 2 weeks to diagnose/exclude the diagnosis of this condition.  

Please speak to your neurologist or your physician regarding this because if possible, you may be eligible for indomethacin (not everyone can take it).  

Hope this information is helpful.  Good luck.