05/12/08 #5 - Migraine since concussion, nerve atlas?

Full Question:
My 15 year old daughter has had a migraine since her concussion on Dec. 13, 2006. She did have a past history with migraines (since 4yrs old) but maybe only 1 every month or 2. She has had MRI, MRA, EEG, CT, blood work. I took her to my chiropractor in January hoping for help. He discovered the Atlas of her C-1 never formed. Neurosurgeons insist this isn't causing the headaches. Also, it was found with the CT that she has a sphenoid cyst...I took her to an ENT for that. He says it can stay-not causing the headache. In May she had a spell where she passed out and had seizure-like activity. Tests show it wasn't a seizure. Again, on July 10 during a NeuroScan test, she passed out w/seizure-like activity. She has been seeing a neurologist since the beginning of March. He has her taking 20mg of Inderal 2x's daily and Trazodone 50mg at bedtime. He feels she is having typical 15yr old girl syncope and wants a tilt table test. I'm not happy with this diagnosis. Maybe if the concussion hadn't happened. What do you think? We're at our wits end with this. She is a very active girl playing sports year round but can't run due to intensifying the pain.
Thanks, Connie
 

Answer:

Dear Connie;

Certainly, your daughter’s concussive injury could be enough of an explanation for a change in Migraine and headache pattern. Indeed, 300 medical and surgical problems can act as promoters, or triggers for migraines. I’m not sure what a neuro scan test is.

My practice has a large component of traumatic brain injury patience and, at least to me, a well crafted EEG is a basic kind of tests that might get some information if seizures are suspected. I assume you mean that the tests that did not show a seizure were an EEG. Of course, EEGs come in different flavors, and it would be good to check whether the person reading the test is board-certified in this subspecialty, as many neurologists are not. In fact, only about 5% of neurologists are boarded in EEG.

Surely, syncopal episodes can be cardiovascular nature and can even be associated with Migraines or headaches. A consultation with the cardiologist may be useful. An interesting side point: trazodone has been associated with exacerbating or increasing headaches and Migraines. It’s not the trazodone, it is the item that it is converted to which is the potential culprit. This is something most physicians do not know about (not their fault).

Good luck,
John Claude Krusz and Teri Robert

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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.