13-year-old son with severe headaches since Sept. 2012?

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    My 13yo started having severe headaches in September 2012.  CT scan, MRI, lumbar puncture and blood tests haven't turned up anything. Migraines run on my husband's side of the family, but these headaches don't seem to be migraines. They would start from the occipital area and come around like a band a few inches thick around his head. He's been on three different anti-depressants, Depakote, indomethacin and two muscle relaxants. None of them have helped. We've tried supplements and elimination diets.  None of the abortives help, either.  He had an occipital nerve block once, but it only took the pain away for four hours. He's had 24/7 severe headache since November 2013. He's gotten several diagnoses depending on who you ask: cervicogenic headaches, chronic-tension type headaches or occipital neuralgia (this from a chiropractic neurologist).  The neurologist we've seen who has a fellowship in headache medicine tried a few medicines, but none brought any improvement and now he says my son needs to stay off medicines and will hopefully outgrow the headaches.  From what I've been able to see in the research, it doesn't seem that there is anything that brings significant improvement in constant pediatric headache.  Is there really nothing likely to help my son? Thanks, Lisa.

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    Full Answer:

    Dear Lisa;


    Your 13 year old son may have chronic daily headache (or, if they came on quite suddenly, New Daily Persistent Headache (NDPH). You can find more information on NDPH in New Daily Persistent Headache – The Basics. Of course, your husband’s side of the family counts as well.  You didn’t mention if the headaches were one-sided or on both sides of the head. The few treatments you mentioned were just that. There are many more approaches, and you didn’t mention any of the headache medications that the specialist gave him.


    From my perspective, we check vitamin D 2 vitamin D 3 levels Red blood cell magnesium, progesterone, Epstein Barr and virus titers, and other items such as homocysteine levels. That are about 300 medical conditions that can be associated with headaches, and about 40 to 50 of them are hormonal in nature. Most doctors, including specialists, do not check for a lot of these potential factors.


    In my own practice, we tend to use a lot of IV treatment probes to see if any medication categories can be found for treatment. So, there are a number of things that can be done by way of the evaluation rather than hoping that your son will simply “outgrow” them.


    Having done a residency in headache medicine is a great start, but that doesn't tell us how much experience your son's doctor has. Remember too that no doctor is the right doctor for every patient. There's nothing wrong with getting a second opinion.

    There are two paces we recommend looking for specialists:

    1. The Find a Health Care Professional widget on http://www.achenet.org, and

    2. the listing of UCNS certified specialists on http://www.migraineresearchfoundation.org/diplomates.html

    UCNS certification is only a few years old. Specialists sit for a big test on "headache medicine" and must pass it for certification. There are some good specialists who aren't UCNS certified because they've been in practice long enough that they choose not to sit for the exam. That's why we recommend looking both places. The ACHE site has some who are very good, but not certified.


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    Good luck on your quest for success and don’t give up!


    Thanks for your question,
    John Claude Krusz



    About Ask the Clinician:

    Dr. Krusz is a recognized expert in the fields of headache and  Migraine treatment and pain treatment. Each week, he and Lead Expert Teri Robert, team up to answer your questions about headaches and  Migraines. You can read more about Dr. Krusz or more about Teri Robert.


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    Last updated May 9, 2014.

Published On: May 09, 2014