Full Question:
My son has been dealing with debilitating migraines since the age of 13 and he is now 17. He had viral meningitis at the age of 6, and his first migraine started after a palate separator was put in his mouth in preparation for braces.
The headaches attacks have dropped in frequency but have become more severe in the past two years. He now seems to cycle every 2-3 months. The attacks always come with severe upper back pain and uncontrollable vomiting (at home), dizziness, and usually last 5-7 days. The triptans and non-narcotic pain and nausea meds (Zofran and others) we give at home do not stop the severe headaches and vomiting. Sometimes Toradol seems to work on milder headaches.
When he is hospitalized, it is because we cannot control the vomiting and pain at home. At the hospital, he takes in fluids and pain and nausea meds through an IV until the pain lets up. It usually takes about 5 days before he begins to feel relief without pain meds and can begin to tolerate noise, light, smells, and drinking on his own. Usually by the seventh day he is able to eat. By the time the headache goes away, he is drained. We have also tried the DHE protocol and it has not helped.
We have been to the pediatric units at Mayo's and the Cleveland Clinic and we are currently seeing a Headache Specialist in Springfield, MO. He is currently taking Depakote which has resulted in an 80 pound weight gain in a nine month period. He has also been on five other preventatives. Over the years, we have tried biofeedback, physical therapy, chiropractic manipulation, exercise program, massage, diet restrictions, diabetic diet, and vitamin regiment and manipulation therapy. We have had MRI's and one MRV...norma.l He was been seen by a Neuro-Ophthalmologist (Cleveland Clinic) who thought he had papilledema but when they performed a spinal tap to measure the increased pressure, we found out his pressure was normal so it turned out to be pseudo-papilledema.
Triggers we have figured out are weather, getting over heated, lack of sleep, and exercise. How unusual is it for severe migraines and nausea to last for 5-7 days? Do you have patients who also have severe back pain during a migraine? Have you used steroids to treat migraine sufferers? Any treatment plan that may be different for patients who have had meningitis? Thank you for your time, Michelle.
Answer:
Dear Michelle;
I feel for your predicament regarding your son’s difficult headache pattern. The symptoms are dramatic and prolonged and certainly worrisome. I’m sure your son’s headache specialist is doing everything possible. I will answer your questions from the last paragraph:
It is somewhat unusual to have migraines with nausea lasting a week but not totally outside the realm of my experience and that of other headache specialists. Back pain can certainly can be an associated symptom for Migraines although, again, this is not a typical feature of Migraine. I and other headache practitioners use steroids all the time to break a severe headache pattern. Indeed, that may be one of the first things to consider in the treatment of a run of Migraines. Your question about meningitis is appropriate even though the headaches began five years later. Many times, post—meningitis headaches will have an element of elevated intracranial fluid pressure and is certainly a treatable on its own. Talk to the headache specialist about lowering fluid pressure.
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