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What Causes Migraine In Children?
Question: Hello. My 5-yr-old daughter has complained of seeing "rainbows" and stomachs for the last 6 months. Both and optometrist and opthamologist have stated that he vision is fine. The pediatrician suggested that they might be the pre-cursor to migraine headaches, which do run in my family. Any suggestions as to what the next step should be?
Brief Answer:
Please tell a few details;
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
If your daughter would have presented to me as an outpatient,I would have asked a few questions in order to answer your query in a better way-
1)Are these symptoms episodic or persistent?
2)If episodic,how long does the each episode lasts?Describe what happens in a typical episode?
3)Any history of headache during the episode?
4)Is nausea associated?
5)Do the symptoms improve on sleep?
6)Any history of seizure or loss of consciousness?
7)Any abnormal birth history or past history?
Please tell these details in follow-up with a better description of her symptoms,so that I can answer your query well.
Waiting for your follow-up.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Please tell a few details;
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
If your daughter would have presented to me as an outpatient,I would have asked a few questions in order to answer your query in a better way-
1)Are these symptoms episodic or persistent?
2)If episodic,how long does the each episode lasts?Describe what happens in a typical episode?
3)Any history of headache during the episode?
4)Is nausea associated?
5)Do the symptoms improve on sleep?
6)Any history of seizure or loss of consciousness?
7)Any abnormal birth history or past history?
Please tell these details in follow-up with a better description of her symptoms,so that I can answer your query well.
Waiting for your follow-up.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dr. Panwar,
Thank you for your time. In response to your questions:
1)Are these symptoms episodic or persistent? Episodic, occurring over the past 8 mos or so.
2)If episodic,how long does the each episode lasts? Generally, less than a few minutes.
Describe what happens in a typical episode? In a typical episode, she sees colored spots, or "rainbows" as she calls them, that move towards her. In the most recent episode, her teacher said they were all sitting in a circle and she said my daughter was non-responsive when she called her and appeared to be "zoned out". After calling her several times, my daughter shook her head and blinked several times and then acknowledged her. I've had similar experiences with her. In addition to the visual disturbances, she complains about stomach pain, also fleeting in nature. While she may have both a visual disturbance and stomach pain the same day, that's not always the case. When they do occur on the same day, they don't typically follow one another. These episodes have occurred inside and out, and not always when moving from one environment to the other.
3)Any history of headache during the episode? No.
4)Is nausea associated? Sometimes nausea, other times she describes it as cramping.
5)Do the symptoms improve on sleep? The episodes are fleeting, so sleep usually isn't needed.
6)Any history of seizure or loss of consciousness? No.
7)Any abnormal birth history or past history? She was born prematurely at 36 wks. She was breech with her head lodged between under my rib cage. As a result of her presentation, she suffered from plagiocephaly and wore a helmet from 9 mos to 18 mos.
Thank you for your time. In response to your questions:
1)Are these symptoms episodic or persistent? Episodic, occurring over the past 8 mos or so.
2)If episodic,how long does the each episode lasts? Generally, less than a few minutes.
Describe what happens in a typical episode? In a typical episode, she sees colored spots, or "rainbows" as she calls them, that move towards her. In the most recent episode, her teacher said they were all sitting in a circle and she said my daughter was non-responsive when she called her and appeared to be "zoned out". After calling her several times, my daughter shook her head and blinked several times and then acknowledged her. I've had similar experiences with her. In addition to the visual disturbances, she complains about stomach pain, also fleeting in nature. While she may have both a visual disturbance and stomach pain the same day, that's not always the case. When they do occur on the same day, they don't typically follow one another. These episodes have occurred inside and out, and not always when moving from one environment to the other.
3)Any history of headache during the episode? No.
4)Is nausea associated? Sometimes nausea, other times she describes it as cramping.
5)Do the symptoms improve on sleep? The episodes are fleeting, so sleep usually isn't needed.
6)Any history of seizure or loss of consciousness? No.
7)Any abnormal birth history or past history? She was born prematurely at 36 wks. She was breech with her head lodged between under my rib cage. As a result of her presentation, she suffered from plagiocephaly and wore a helmet from 9 mos to 18 mos.
Brief Answer:
Focal or partial seizures/MRI Brain/EEG
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
First of all,I just want to praise the way you have presented the answers to my questions.It's just a beautiful way and now the things make good sense.
My clinical impression is that your daughter is having partial or focal seizures,whiah may be simple partial or complex partial.
Next step for you is to get the following investigations done-
1)Magnetic resonance imaging(MRI) of Brain with Epilepsy protocol.
2)EEG(Electroencephalogram) or preferably video EEG.
EEG should be done as close ( with respect to time frame) to a typical episode as possible to increase the yield of EEG.
Once the diagnosis is confirmed,we can start antiepileptic drugs.
Hope that I have answered your query.If you have some further queries,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Focal or partial seizures/MRI Brain/EEG
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
First of all,I just want to praise the way you have presented the answers to my questions.It's just a beautiful way and now the things make good sense.
My clinical impression is that your daughter is having partial or focal seizures,whiah may be simple partial or complex partial.
Next step for you is to get the following investigations done-
1)Magnetic resonance imaging(MRI) of Brain with Epilepsy protocol.
2)EEG(Electroencephalogram) or preferably video EEG.
EEG should be done as close ( with respect to time frame) to a typical episode as possible to increase the yield of EEG.
Once the diagnosis is confirmed,we can start antiepileptic drugs.
Hope that I have answered your query.If you have some further queries,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Shanthi.E
Thank you again, Dr. Panwar. The potential diagnosis concerns me, but after reading more about the condition, it makes sense ans I am glad to have it for discussion purposes.
One follow-up question, the weekend before last she quickly developed a 103 fever, but had no other symptoms aside from some stiffness in her neck. Throughtout the day she was letharic, a little loopy and complained of seeing "fainbows" several time. The fever did not seem to be responding to medicine and after she vomited, I consulted with her pediatrician over the phone (as it was Saturday night). She suggested taking her to the ER to ensure it wasn't meningitis, or strep throat. I mentioned the rainbows and stomach pain to the ER doctor, but he didn't seem concerned. The strep culture came back negative, so he gave her anti-nausea medication and sent us home. My thought was that it might have been a GI virus, as she did have diarrhea the following two days, but was otherwise fine. I know a fever can cause seizures in some cases, so perhaps she had some throughout the day? I assume seizures themselves don't cause fevers?
One follow-up question, the weekend before last she quickly developed a 103 fever, but had no other symptoms aside from some stiffness in her neck. Throughtout the day she was letharic, a little loopy and complained of seeing "fainbows" several time. The fever did not seem to be responding to medicine and after she vomited, I consulted with her pediatrician over the phone (as it was Saturday night). She suggested taking her to the ER to ensure it wasn't meningitis, or strep throat. I mentioned the rainbows and stomach pain to the ER doctor, but he didn't seem concerned. The strep culture came back negative, so he gave her anti-nausea medication and sent us home. My thought was that it might have been a GI virus, as she did have diarrhea the following two days, but was otherwise fine. I know a fever can cause seizures in some cases, so perhaps she had some throughout the day? I assume seizures themselves don't cause fevers?
Brief Answer:
Fever precipitated the seizures here.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and appreciating.
Of course,with this scenario,I am convinced that fever precipitated the stream of seizures that day.Lack of sleep,excessive stress,fever and infections usually precipitate seizures in patients of epilepsy.
Seizures rarely,can cause fever but not the partial or focal seizures.They are usually generalised tonic-clonic seizures,which if persistent(status epilepticus),may cause fever.But,its rare,very rare.In fact,for all practical purposes,seizures don't cause fever.
Hope that I have answered your query.If you have some further queries,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Fever precipitated the seizures here.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and appreciating.
Of course,with this scenario,I am convinced that fever precipitated the stream of seizures that day.Lack of sleep,excessive stress,fever and infections usually precipitate seizures in patients of epilepsy.
Seizures rarely,can cause fever but not the partial or focal seizures.They are usually generalised tonic-clonic seizures,which if persistent(status epilepticus),may cause fever.But,its rare,very rare.In fact,for all practical purposes,seizures don't cause fever.
Hope that I have answered your query.If you have some further queries,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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