?Migraine? 10 year old

[Pat-Szuba]

  My 10 year old son recently has had 2 episodes of unilateral headaches,
  accompanied by scalp tenderness, nausea and sometimes vomiting.
  Some general history: He was diagnosed with asthma at age 7.  He has known
  allergies to mold(highly), dust, animals, grass and tree pollen.  Last year
  he had a bronchoscopy (at Johns Hopkins-ped pulmonary) due to a
   uncontrollable cough, which found his lungs
  had been bleeding. As explained to me they found macrophages(spelling??)
   that feed on hemo-
  ciderin.  But after additional testing, did not find any specific cause
  and chalked it up to either viral or allergic response.
  He has also complained of unexplained abdominal pain that would last 2-3
  days.  He's has about 5 episodes of this per year for the last three years.
  He had an upper endo(also at Hopkins) which was relatively normal,
  although he does show physical signs of reflux and minor reflux was
  demonstrated on an upper GI.
  He now takes Prilosec for reflux (which did seem to help), Beclovent
  inhaler-2 puffs 2x's a day, Vancenase pockethaler-2 puffs in each nostril
  2x's a day, and Claritan.  Even though it sounds contradictory, he appears
  healthy as a horse, is very athletic. Just puffs on his Proventil inhaler
  before every sporting event. He is a good student and likes school(was
  sent to a psychologist to determine if this was school related--answer
  was no--and I strongly concur)
  Now, to the headaches
  The first episode, approx one month ago, lasted for 3days and just went
  away as fast as it came.  No relief
  was gotten from Tylenol or ibuprophen.  It was blamed on his increased
  steroid dosage(inhaled Beclovent).  He had an asthma attack a couple days
  before that.  
  The second just days ago, came thundering upon him in the middle of the
  night and woke him out of sleep.  Right sided pain around the temporal-
  parietal region.  By the 2nd day, his pediatrician put him on Midrin, but
  after 6 doses, it didn't seem to help and on the third day we tried Imitrix
  nasal spray.  Still complained of the headache and nausea, but the scalp
  tenderness diminished.  He still has a headache and nausea today.
  By the way,he had a BIG chocolate candy bar before he went to bed that
  first night.
  Upon physical exam, he was also tender in his RUQ and he's having a GB
  sono today.
  My pediatrician is wondering if there is a link between the abdominal
  pain episodes and the now ?migraine headaches.  She says that migraines
  in children often appear that way.
  Do you think the Prilosec may be a cause?  He's been on that for 6 months.
  We have taken him off of it for now.  He's also been tested for common
  food allergies and that was negative.  He does seem to have an intolerance
  to liquid milk, but not milk products in moderate doses.
  What can I do for prevention, without getting over medicated.  He takes
  so many things already.  I read about feverfew, but understand you don't
  recommend it.
  With all I've thrown at you, can you link any of this together?  
=====================================================================
It is probable that some of this is linked , but unlikely that everything can be made into one neat package. I suspect the allerfies and pulmonary problems form one separate component which is unrelared to his neurological symptoms.
The headaches definitely sound like migraine, the history is very typical especially the inilateral nature and history of chocolate intake. It is possible that the abdominal pains may be related to the migraine , this does occurr in children, but this is a diagnosis of exclusion and there is no specific test, I would not accept this theory until it has beeen fully investigated.
In terms of recommendsations I will confine myself to the neurological issue only,it would appear that his headaches are relatively rare so identification and avoidance of precipitating factors is the key, there are many abortive medications available, includiing Zomig, Amerge, and Sumatriptan, these should be used in the acute situation as his headaches are not sufficiently frequent aat this stage to merit constant preventative therapy. There is no documented link with Prilosec as a contributory factor to
migraine.