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Suggest treatment for migraine

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Posted on Tue, 7 Jun 2016
Question: My 14 year old daughter has had a continuous migraine for over 10 months. It is always focussed on the side of the temples, and averages 5 out of 10 on the pain scale every day - all the time. While we have not found anything that makes it better, being in a moving car - especially braking, makes it worse, along with loud noise, and going up stairs, lifts, or spinning. She only has the pain, no blurred vision or nausea. She is on 50mg Topimax twice daily, and there has been no improvement. She has tried accupunture, chiropractic treatments, massage, osteo, diet changes, to no effect. Eyes have been checked. Ears as well, but only by paediatrician. MRI at beginning, nothing showing there. No pain killers are working either - codeine just makes her sick, tried Rizamelt and that made her throat squeeze (felt like being strangled), then took the pain down 1 point, and when it wore off, the pain went up 2 points from where it started. Tried that 3 times to check. At a loss to find something to help. Desperate for help.
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Answered by Dr. Sumit Bhatti (3 hours later)
Brief Answer:
This will require further investigation.

Detailed Answer:
Hi,

Thank you for your query.

1. From her history, you should get her hearing and ear pressures checked. A PTA (Pure Tone Audiometry) and an Impedance Audiometry (Tympanogram). An ear drum examination should be done.

2. HRCT Scans of the Temporal bones, sinuses, cervical spine (128 slice) and a 3 Tesla MRI of the Temporal Bones including a contrast and blood flow study should be done. Conditions to rule out include Superior semicircular canal dehiscence, cervical spine abnormalities, Idiopathic Intracranial Hypertension. This will also require fundus (eye) examination.

3. Rizatriptan does cause tightness in the throat and chest. Topiramate is not tolerated well by all patients. Request a trial with flunarizine.

4. Her headaches seem to be related to menarche/puberty. An abdomen and pelvis USG (Ultrasound) should be done. Consult an endocrinologist.

5. Upload the results of these examinations and investigation to discuss further treatment options.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumit Bhatti (40 hours later)
Thank you for your answer. We are working on getting these tests done, however it may take a while.

Regarding the possibilities of what this could be, would driving long distances or flying (as they cause her pain to increase) be something best avoided, or will they do no further damage? I am asking because she is being asked to visit relatives 6 hours drive away, and is concerned about the long term ramifications of driving such a distance, and then to return in 4 days later, with another 6 hour drive, or 1 hour flight.

Your guidance would be gratefully appreciated.

Kind regards
XXXX (XXXX mother)
doctor
Answered by Dr. Sumit Bhatti (14 hours later)
Brief Answer:
Travel is best avoided.

Detailed Answer:
Hi,

Thank you for writing back.

1. Travel is best avoided.

2. If not, driving will be better that a flight.

3. You can upload the results here or directly at bit.ly/Dr-Sumit-Bhatti

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2662 Questions

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Suggest treatment for migraine

Brief Answer: This will require further investigation. Detailed Answer: Hi, Thank you for your query. 1. From her history, you should get her hearing and ear pressures checked. A PTA (Pure Tone Audiometry) and an Impedance Audiometry (Tympanogram). An ear drum examination should be done. 2. HRCT Scans of the Temporal bones, sinuses, cervical spine (128 slice) and a 3 Tesla MRI of the Temporal Bones including a contrast and blood flow study should be done. Conditions to rule out include Superior semicircular canal dehiscence, cervical spine abnormalities, Idiopathic Intracranial Hypertension. This will also require fundus (eye) examination. 3. Rizatriptan does cause tightness in the throat and chest. Topiramate is not tolerated well by all patients. Request a trial with flunarizine. 4. Her headaches seem to be related to menarche/puberty. An abdomen and pelvis USG (Ultrasound) should be done. Consult an endocrinologist. 5. Upload the results of these examinations and investigation to discuss further treatment options. I hope that I have answered your query. If you have any more questions I will be available to answer them. Regards.