My 14 yo son has migraine with aura (never, ever gets it without the aura). Began about 2 yrs ago, by 18 months ago he'd noticed they were every 6 wks. By one year ago, every 4 wks. By 6/10, every 2 wks, by 9/10 twice/wk, by 10/10 every two days. Now he will have an episode, then another 16-24 hrs later, then might go up to 48 without. Has at least 5/wk now. Has visual aura, then 12 hours severe HA. Doesn't have N/V with them, but last June had post-migraine nausea, now is having an episode of post migraine nausea/vomiting again, but since it rarely happens, we don't know if it's anything to do with the migraine, may be coincidental viral gastro, but he doesn't have diarrhea.
Migraine runs strongly on both sides of the family. Mine began perhaps 6-12 months before first signs of pubertal development, were NEVER this frequent. I tried Tylenol and aspirin, which did nothing, then just suffered through them. They became less frequent after puberty. Eventually they turned into rare acephalgic migraine, as had my mother's. My spouse had infrequent acephalgic migraine in his 20s, family members with migraine with and without aura. My son is now, finally, in early puberty, so his pattern seems to be following mine, but with such frequent episodes!
We've been through 3 oral triptans without any effect, also 5 prescription preventatives without any effect, also 4 alternative preventatives without any effect. Currently, we're beginning a trial of Topamax.We give him Tylenol with codeine at the onset of the migraine. He says it takes the pain from a 10 to a 7. He hates to take it, because he hates the heavy, drugged feeling it gives him, but ibuprofen and acetaminophen give no pain relief whatsoever. The most Tylenol with codeine he's ever used during a migraine are 1 1/2 tabs repeated once, lately he takes only one and doesn't repeat it. We have an intake appt. with the pain clinic at the local children's hospital next month (first available), an appt. to begin biofeedback next week (also first available), and now an emergency appt. with the MD from the pain clinic tomorrow.
My question is, should we stop using any rescue medication and just suffer through? After having read Teri's summary of the results of the AMPP, I'm worried about using ANY rescue medication at all for him, and frankly, the narcotic is the only thing that has worked at all. I do know that we are not finished trying the rest of the triptans, but with his migraines coming so frequently, even if we did find one that helped, I don't know if we could use it that often. I don't think that he's having transformed migraine, because each episode always comes with aura. I think that his increased frequency is due to rising levels of testosterone, not medication overuse. But, there's no question that his migraines have become much, much more frequent, and that we have used some ibuprofen, acetaminophen, and codeine. I don't want to do the wrong thing here. I'd hate to think that the little bit of Tylenol with codeine that he's used has put him where he is today - essentially disabled by migraine. Could this be transformed migraine already? Should we try to tough it out with nothing? Do people with transformed migraine, who stop using pain meds, ever have the transformed migraine resolve?
