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Brain MRI done for 6 year child. Have chronic headache, nausea and vomiting. Will it get worse with the age?

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My daughter who is 6 years old had a brain MRI done recently as she has chronic headaches, specifically in the forehead region. Sometimes it gets so bad that she has extreme nausea & occasional vomitting. The MRI concluded that:
1. XXXXXXX There is mild cerebellar tonsillar ectopia into the foramen magnum without evidence of overt Chiari malformation.
2. There is also focal sphenoid sinus mucosal disease. It is unclear whether this represents disease within a dominant left sphenoid sinus or complete opacification of a hypoplastic right sphenoid sinus XXXXXXX

My question is what does this mean? & How serious is it? Can it get progressively worse as she gets older?

The only other symptoms or medical history she has is that she is a bad sleeper. She wakes as often as once every night, sometimes up to 3 times a night. We had a sleep study done about 2 years ago & it discovered mild sleep aponeia & "abnormal brain activity" which suggested mild seizures in her sleep. A further sleep study was done during the day & it ruled out epilepsy?
Posted Sat, 18 Aug 2012 in Child Health
Answered by Dr. Neeraj Baheti 10 hours later
Firstly does these headache precipitate by cough, lead to graying of vision?
does anybody in family have migrainous headache? These headcahe could very well be due to migraine.
Regarding tonsilar ectopia in foramen magnum. This could represent type I chiari malformation or normal. The doctor has mentioned in the report that there is no overt Chiari malformation. Hence i conclude it may be a normal variation.
You can ask how many mm is tonsillar descent. But for now don't worry even if it is chiari malformation we have to just keep a watch and follow-up.
Secondly there is evidence of sphenoid sinusitis on left and right sinus is underdeveloped. This means you need to consult an ENT specialist for Rx of above. This could even be the cause of headache. But this is not at all a concern for me. With treatment this will clear off.
Keep a watch on her sleep pattern if she is becoming apneic or wakes up as if woken from bad dream then consult neurologist again.

Should you have any more concerns just feel free to consult.

Best Wishes,
Dr. Neeraj Baheti
Above answer was peer-reviewed by
Follow-up: Brain MRI done for 6 year child. Have chronic headache, nausea and vomiting. Will it get worse with the age? 5 hours later
Thank you so much for your response.

She has no cough, so my answer to your first question is no. She has complained of blurry vision but the optometrist says her vision is fine.

I am a migraine sufferer. My first migraine was at 15 years old. I think I have what is called the XXXXXXX type migraine, with the flashing lights, tunnel vision, intense headache accompanied with nausea or nausea & vomitting, sensitivity to light,etc.

What would I need to keep a watch for & follow up with regard to the chiari malformation?

When she wakes up at night she is crying & scared & says she had a bad dream, my concern is, this happens as often as every night & up to 3 times a night. A sleep study we conducted about 2 years ago suggested sleep aponeia (no treatment given) & "abnormal" brain waves or activity. The doctor said it suggested seizures in her sleep. A further sleep study during the day ruled out epilepsy. What are the chances this is all linked together? Would it be worth doing another sleep study?

Thank you again.

Answered by Dr. Neeraj Baheti 20 minutes later
I can understand your concerns.
the headache could very well due to migraine so just treat on those lines.
Firstly as far as chiari malformation goes. Just be under follow-up of local neurologist.
Watch for
persistent neck pain, problems with balance, numbness and tingling of the hands and feet, dizziness, difficulty swallowing (choking and vomiting), Vision problems (blurred or double vision), Slurred speech.

The sleep apnea seems to be related to Chiari Malformation. Both obstructive and central sleep apnea is common in children/adults with Chiari malformation. You can consult with your sleep medicine specialist again with the imaging findings. The may
repeat sleep study and guide you accordingly.

Best wishes,
Above answer was peer-reviewed by
Follow-up: Brain MRI done for 6 year child. Have chronic headache, nausea and vomiting. Will it get worse with the age? 4 hours later
Sorry Dr XXXXXXX one more question, actually 3 more. Is it possible to get migraine headaches 3-5 times a week? Is it o.k to give her Panadol that many times a week? What can I give her when Panadol isn't enough?

Thanx again.
Answered by Dr. Neeraj Baheti 14 hours later
Migraine headaches can be frequent. As frequent as daily. Ideally analgesics like Panadol should not be given more than once or twice a week.
Firstly visit ENT specialist to look out for that sinus problem since this can also be a cause.
Secondly, visit your neurologist again. He/she will correlate everything, look for other features to confirm if it can be migraine and if so will put child on regular treatment so that the intensity and severity decreases. He/She will also guide about rescue medications.

Best wishes,
Above answer was peer-reviewed by
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