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Ask The Expert Archive

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Pediatric Headache and Hospitalist Archive Questions

Below are Dr. Gladstein’s answers to Pediatric Headache and Hospitalist questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 20.

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Q : 1

My son suffers from headaches in the right side of his head and has dizziness, or claims that he doesn't feel good in his stomach, but can't explain the type of pain in the stomach. He also gets car sick. His pediatrician has told us that they are migraines. We usually give him motrin and he does feel better after it takes effect. The question is if he should he take something for the nausea/car sickness? Sometimes they come without the headache, so we don't know what symptom should we treat.

Try having him face front. Make it forbidden to look down. He must face forward and stare at a fixed point. This often alleviates the need for medication. The problem is that the medications make you sleepy, so not a good idea if possible.

Q : 2

My teenage daughter has had a headache for two solid months. Her current neurologist thinks it is a tension headache but now I'm wondering if it is a New Daily Persistent Headache. Would the treatment be different?

Yes, by definition is it new persisant daily headache. Until the doctor visit, make sure she goes to school, get regular sleep and eats properly.

Q : 3

My 12-year-old son was diagnosed with migraines at age 4. He had been only getting them occasionally until two months ago when the frequency and severity increased. His pediatrician has started him on Amitriptyline. Should he get an MRI or CT scan?

Yes. A change in pattern after a long period of time means that he needs an MRI.

Q : 4

Have you ever seen patients who get migraines due to dramatic changes in barometric pressure/fronts? My son gets debilitating migraines (sensitive to noise, light, and the pain escalates until he vomits) every time there is a significant low-pressure front. Have you heard of this?

Yes. This is relatively common in children who experience migraines.

Q : 5

My daughter is under the care of a pediatric neurologist, but we can't get her migraine under control. She is going on 11 days of pain. What can we do for her?

She may need to be admitted to a children's hospital, to get IV medication for a few days. Medications include IV steroids, DHE, Reglan, magnesium and Depacon. Please feel free to share this list with your peds neurologist who may be willing to admit your daughter for these medications.

Q : 6

How is morphine administered to treat migraine headaches? If by injection, where?

Morphine use to treat migraines is not encouraged because it is habit forming, stops working very soon, and requires escalating doses that cause side effects. So the short answer is not to use morphine or any narcotics to treat headaches.

Q : 7

My seven year old daughter has had a constant headache, dizziness, body soreness, and earache for 17 days; she has not had a fever. She's seen numerous specialists, but no answers. Tylenol, Motrin, and hydrocodone don't help the headache. Could it be a pediatric migraine?

A migraine should not last 17 days. There is an entity called New Daily Persistent Headache. Treatment requires medication and patience. She needs to see a pediatric neurologist to make sure she does not have something serious neurologically . She will need an MRI with particular focus on the acoustic nerve.

Q : 8

Can you recommend some alternative medications or treatments for a 6 year old with chronic, daily headache?

You could try magenesium, feverfew, coenzyme Q10 or vitamin B2.

Q : 9

My 3-year-old son has recently started playing his older sister's Nintendo DS. This morning, as he was playing it, I noticed his arms seemed very shaky. I made him turn it off and he then started complaining that the back of his head (towards the bottom) was in pain. I remember hearing a long time ago that game systems can cause seizures so I am concerned about that as well as if they can cause headaches.

This doesn't sound like a reason to be alarmed. If it happens a second time, you should have him evaluated.

Q : 10

Do you see adults? Where is your office?

I see patients up until their 21st birthday. Our office is at UMMC and I also see patients at Upper Chesapeake Hospital once a month.

Q : 11

My 14-year-old son has started having tremors in both his arms as well as a severe headache for the past 48 hours. He has been to the ER twice in the past 24 hours. He saw a pediatric neurologist who said it could be psychogenic tremor or a migraine. The first time to ER they treated for tremors, second time for migraine. I'm not sure what to do next. He woke up again with tremors and a headache. Any advice? His blood work was normal as was his cat scan.

He needs an MRI to rule out any problems that may be in the back of his head that a cat scan will not see. If that is OK, he needs better treatment for the headaches. The tremor is not worrisome if the MRI is OK. You should arrange the MRI with your pediatrician.

Q : 12

What treatments for daily, long-term, chronic headaches other than SNRIs have you used?

I have used various medications, herbs, vitamins, relaxation hypnosis, biofeedback and injections such as botox and nerve blocks.

Q : 13

My 13-year-old son has been experiencing migraines for the last 1.5 years. He has tried several different preventative medications with little success. Since 90 percent of his migraines are present when he gets up in the morning, could there be a connection to his sleep cycle? If so, is there any benefit in having a sleep study performed?

Usually, there isn't a connection between the sleep cycle and migraines unless your son has a history of sleep apnea. If this were the case, he would also have a history of snoring and restless sleep.

Q : 14

What types of headache medication are safe for people with Sickle Cell Disease? Can medications that constrict blood vessels like Elavil be used?

Preventative medications are all safe. Most people shy away from the use of triptans for acute headaches.

Q : 15

My daughter has headaches as a result of TMJ. Is this something that can be treated?

She would have to be evaluated, but some patients who have headaches as a result of TMJ see relief with a bite plate made by a dentist and learning relaxation exercises specific to their condition.

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