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Neurology (Expert Forum)
Please help with son's chronic daily migraines, dizziness
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Please help with son's chronic daily migraines, dizziness
by baconc, Dec 06, 2004 12:00AM
My son, almost 15, has had chronic migraines with severe dizziness for 15 months. He's had some good months, but last fall and this fall have been awful. He's missed more than four straight weeks of school. An EEG and MRI with contrast last Dec. were normal as was recent visual field test. Food does not trigger; he eats the same things during months when he's fine as other times.
Something environmental or weather seems to lower threshold, then most common trigger is light. Optometrist believes it involves the nerve that causes the pupil to shrink rapidly when going from dark to light suddenly.
Since Oct. '03 we've been seeing a pediatric neurologist, but he's not been attentive to the dizziness. We've tried multiple triptans; all ineffective. Antivert, diazepam and valium all were useless for dizziness. Current meds: Allergy shots; Nortriptyline (25 mg/a.m. and 50 mg/ p.m.); began Depakote in the spring and initially improved, but the neuro increased it from 250 to 500 then 1000 mg daily this fall and with each increase he seemed to get worse instead of better.
He has seen a neuropsychologist for neuro-feedback for several months - somewhat helpful, but not covered by insurance; neurologist recommended we try biofeedback, which we'll finally be able to begin this week. Recently, after consulting with our pediatrician and the neuropsychologist we have begun weaning him off the Depakote. He's taking Lexapro (10 mg/day) to relieve anxiety about missing so much school, and the constant pain. We will see a neuro-ophthalmologist in 3 wks. Help, please.
Something environmental or weather seems to lower threshold, then most common trigger is light. Optometrist believes it involves the nerve that causes the pupil to shrink rapidly when going from dark to light suddenly.
Since Oct. '03 we've been seeing a pediatric neurologist, but he's not been attentive to the dizziness. We've tried multiple triptans; all ineffective. Antivert, diazepam and valium all were useless for dizziness. Current meds: Allergy shots; Nortriptyline (25 mg/a.m. and 50 mg/ p.m.); began Depakote in the spring and initially improved, but the neuro increased it from 250 to 500 then 1000 mg daily this fall and with each increase he seemed to get worse instead of better.
He has seen a neuropsychologist for neuro-feedback for several months - somewhat helpful, but not covered by insurance; neurologist recommended we try biofeedback, which we'll finally be able to begin this week. Recently, after consulting with our pediatrician and the neuropsychologist we have begun weaning him off the Depakote. He's taking Lexapro (10 mg/day) to relieve anxiety about missing so much school, and the constant pain. We will see a neuro-ophthalmologist in 3 wks. Help, please.
Doctor's Answer
by CCF-Neuro-M.D.-CS, Dec 08, 2004 12:00AM
This is a very complicated case and may represent a form a migraine which can be associated with dizziness. It would be reasonable to obtain a second opinion at a center with a pediatric headache specialist and a neuro-otologist (dizzy doctor). We have both here at the Cleveland Clinic Foundation. The doctor I would recommend seeing first is A. David Rothner. He is a well known pediatric headache specialist. He wil be able to review your case and make further recommendations. In addition if a consultation with a neuro-otologist is necessary, this can be arranged. Good luck.
both red-flags for a possible tethered cord. If you read my other posts, I have been diagnosed ( neurosurgeon at Cedars - Sinai med. center) with congenital adult tethered cord - came with my inherited spina bifida occulta. I also had migraines in mid teen to early 30s. Please read about
tethered spinal cord and Arnold Chiari malformation.
( Two good sites - World Arnold Chiari Malformation Assoc. and American Syringomyelia Alliance Project)