Dr. Hitesh Kumar
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My 10-year-old son is debilitating with almost daily chronic headaches (seem to be migraines), which are worse at night as he gets slightly dizzy, and he says it hurts to walk. The MRI (magnetic resonance imaging) is clear, and there are no eye pressure issues or eye problems, and there is bloodwork in the reports. He was taking 30 mg Amitriptyline and 250 mg Magnesium oxide per day.
Hello,
Welcome to icliniq.com.
I would like to know some further details about a headache (you will need to ask questions from the boy):
1. Since when he started to have these headaches, and for how many years?
2. In which part of the head he feel headaches? (you can attach your photo, clicked from a little distance, with the hand kept over part of the head, where you feel headache. Can attach 2-3 photos from front and sides if headache area is large).
3. What kind of headaches he feels? Heaviness or bursting or squeezing or stretching or throbbing or some other kind?
4. One episode of headache lasts for how long duration (without pain killer tablet)?
5. Does he feel any nausea or vomiting during the headache episode?
6. Is headache associated with any redness in the eyes or watering from eyes or nasal blockage?
7. Have he noticed any specific trigger factor or timing for this headache till now?
8. How frequent are these headaches nowadays? (how many times in a month)
9. How is the intensity of headaches, mild or moderate, or severe?
10. Since when is he taking 30 mg Amitriptyline and 250 mg Magnesium oxide per day? And what is a change in headache frequency and intensity with these medications?
Other information:
1. How is his sleep in routine? Do you get sleepy soon after lying in bed? or it takes a long time? Once you got sleepy, do you have frequent awakenings during sleep? Do you feel fresh on awakening from sleep in the morning?
2. How is his usual mood (How he feel inside about self) in day-to-day activities? Happy or toward the sad side (thinking about past events) or toward the worried side (thinking about future things or irritable or something else)?
3. How is his behavior at home and in school? (irritable or restless or angry or polite and soft-spoken or seem interested in play and extracurricular activities)
3. How is his appetite?
Patient's Query
Thank you doctor,
1. These started around giving two to three times per week.
2. Changes from right to left like a typical migraine. However, in the last few weeks, his pain at night has also migrated to just above the temple of whichever side is throbbing. Additionally, I just asked him where does it hurt when he says, "it hurts to walk," and he says it always hurt in that area above his temples.
3. I have a throbbing headache.
4. There has been no relenting, so it is hard to say. He has literally had a headache since February. The pain may lessen, but it has not gone away.
5. He does occasionally feel nauseous and will vomit. It does often make him not want to eat, especially during breakfast and dinner.
6. He has not been associated with headaches, redness in the eyes or watering from the eyes, or nasal blockage. He was recently given an allergy test and had absolutely no allergies.
7. The only trigger making pain worse is physical exertion. He wakes with a headache, but it worsens as the day goes on.
8. Every single day, he has headaches.
9. The intensity of the headache is mild but mostly moderate upon waking and becomes severe by bedtime.
10. I just increased from 20 mg to 30 mg of Amitriptyline about a week ago. Before that, he had been taking 20 mg for at least a month. And before that, 10 mg for at least a month.
Other information:
1. How is his sleep in routine? In bed every night by 8:30 pm. Do you get sleepy soon after lying in bed? or it takes a long time? It takes 20-30 minutes. Once got sleepy, do you have frequent awakenings during sleep? Not that he is aware of - Do you feel fresh on awakening from sleep in the morning? Yes, aside from headache pain.
2. How is his usual mood (how he feel inside about self) in day-to-day activities? Happy or toward the sad side (thinking about past events) Only sad about missing out on school, friends, and sports because of the headaches or toward the worried side (thinking about future things or irritable or something else). Again, only worried because he has missed so much in the past five months?
3. How is his behavior at home and in school? (irritable or restless or angry or polite and soft-spoken or seem interested in play and extracurricular activities) polite, sweet, artistic, but missing baseball and friends.
3. How is his appetite? On good days, it is great. On bad days, he does not eat much at all.
Hello,
Welcome back to icliniq.com
It is a little odd for migraine headaches that pain started and within two months became daily headaches.
Usually, migraine headaches are intermittent for a long period (few years) and thereafter can become daily headaches. Also, headaches are not severe intensity. It is the moderate-intensity at peak, and headaches are not disturbing sleep, though the maximum intensity is at night time only. The plain MRI brain is normal (attachment removed to protect the patient's identity).
Does the child has any other associated history clue:
1. History of frequent nose blocks or intermittent running nose or nasal congestion?
2. Change in behavior (compared to before) like child became stubborn or very demanding or moody or fight with siblings?
3. Any history of photosensitivity (face or cheeks turning red in sunlight) or joint pains or joint swelling or recurrent mouth ulcers.
4. Any recent significant emotional setback to a child?
5. Does someone in a close family has frequent headaches or migraine headaches?
This pattern of headache is not typical of migraine headaches. It is mimicking more tension headaches with chronic daily headaches. In children, psychogenic headaches are very common (much more common than migraine headaches), associated with tantrums. However, I need to search for the organic cause, too, and try doing further evaluation. Psychogenic factors also need to be assessed properly.
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Neurology
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