Suggest Treatment For Severe Migraine In A Child

Posted on Thu, 2 Feb 2017

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 2 Feb 2017 Answered on

Mon, 27 Feb 2017 Last reviewed on

Question : 12 year old daughter. Migraines last 2-3 days usually end in ER visit to get "cocktail" treatment. Have imatrex, amitriptalin, reglin, mecazine and other drugs don't work. Also has extreme dizziness ( vastibular disorder). All diagnosed in Sept.Now starting Monday has concentration problems, forgetfulness, confussion and left finger numbness. All started within last week. Doctors say not to worry! I'm worried. MRI/MRA negative taken in November. Also has extreme neck and shoulder pain. Has missed 68 days of school this year. Besides this she does have Anxiety. On Busbar and Celebrex.

Answered by Dr. Ishu Bishnoi (1 hour later)

Brief Answer:
Cause of deranged psychological functions and management

Detailed Answer:
Hi XXXX, thanks for asking from HCM.

I can understand your concern. Your daughter is suffering from severe pain. She has been prescribed too much medications. Most of these medications affect higher mental function like memory, concentration, alertness, tingling, fatigue. The medication which are causing these symptoms, are sumatriptan (Imatrex), amitriptyline (amitriptalin), buster (buspiron), metoclopramide (Reglan), Topiramate (Topamax). I am really concerned about use of so many drugs. It is better to use injectable pain killer or patch or opioid drug rather than use of so many CNS affecting drugs.

The good thing is - there is no brain lesion. She is having severe "Migraine". My advise is to

- Avoid food which can trigger pain, e.g. fried food, fast food (burger/pizza), cheese, chocolate, cold drinks
- Avoid bright light like sunlight/mobile/laptop
- Avoid mental stress
- Avoid lack of sleep. At least sleep for 8 hours daily.
- If she is having menstruations, better to give painkillers like Celebrex at that time to control pain and prevent occurrence of Migraine.
- Ask your doctor to give medication which can delay the attack of migraine. The drugs are Propranolol, Amitriptyline (already taking), Topiramate (already taking), Pregabaline, Gabapentine. Try to maintain her on single drug rather than two.
- Avoid metoclopramide. Rather than this, ask your doctor about domperidone. Domperidone does not affect CNS.
- For pain attack, if no relief even with sumatriptan, she can take opioid medication for short duration e.g. Oxycodone.
- Yoga and meditation will help in reducing stress, pain and increase her alertness.

Hope it will help her. If still in doubt, do let me know.
Thanks. Take care.

Above answer was peer-reviewed by : Dr. Kampana