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Dr. Muneeb Ali
Dr. Muneeb Ali, Doctor
Category: Medical
Satisfied Customers: 16598
Experience:  MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
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My 15 year old son is suffering from migraine .counties

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hi,my 15 year old son is suffering from migraine .counties headache has ruined his life .
JA: How long has your son had the headache? Has he used any medication for it?
Customer: from four years ago .yes indrol +pvopranslol,hitop
JA: Has he seen a doctor about the headache?
Customer: yes lots of doctors ,specialist at this moment he is taking medicine .doctor diagnose that it is chronic migraine
JA: Anything else in his medical history you think the doctor should know?
Customer: no I don't think so.

Hi,
Welcome to JA and thanks for this question. I'm sorry to hear about your son's symptoms. Can I ask has your son had an MRI of the brain done? Apart from inderal, hitop has he been given any other medications to try and control the migraines? Additionally, how often does he get an attack, how many times a month?

Customer: replied 9 months ago.
hi,unfortunately he is suffering continuously. any kind of mental and physical exertion make it worse .then fever starts so most of the time he is in bed.done mri as well it is normal only small cyst (2*1cm frontal extraaxial fluid collection) with medicine he is able to sleep at night .but pain is not going any where

Thanks for the additional information. I will get back to you with a written answer within a few minutes. Thanks for your patience.

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Customer: replied 9 months ago.
at this moment he is taking two medicine which is indral 40 mg tab topagen 50 mg .

Actually, migraines should NOT be causing this much pain, migraine attacks should not occur on a daily basis and if they occur on a daily basis then they do require serious interventions. FIrt of all, we need to confirm that this is truly migraine and not anything else, it needs to be confirmed that the cyst is not causing him these headaches. While it is not likely that a cyst of this size would be responsible for these headaches it is certainly possible especially if the headaches are localized to that region of the head. If the cyst is found to be responsible for the pain then it should be managed with drainage. Your neurologist should be able to confirm this by examining him thoroughly and possibly even repeating the MRI scan if it was done more than 6 months ago.

Now if migraines are found to be the cause then his medications need to be changed, the medications which he is on currently are used to prevent attacks of a migraine however they clearly don't seem to be working. Usually, preventive medications are successful limiting the attacks to once or twice a month but here he is in constant pain which is not right. Basically, he should have medications like sumatriptan or zolmitriptan to abort acute attacks on hand or even simple medications like ibuprofen or naproxen along with a muscle relaxant like tizanidine (movax) which would provide immediate relief. In addition the dose of topagen should be increased to 100 mg a day if 50 mg is not working to control the attacks however there are other options which can be tried which include,

Valproic acid

Amitriptyline

Flunarizine

Calcium channel blockers

Acetazolamide

If those do not work then in refractory cases we can inject botox into his scalp muscles which can help manage the severest forms of migraines. My suggestion is to visit his neurologist once again and have him change the medications or discuss getting botox for him, botox injections do work well in teenagers. Additionally, I have found that amitriptyline seems to work well in male teenagers of his age group so it would be worthwhile to try using that drug here.

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Customer: replied 9 months ago.
apart from that doctor gave him to try painkillers but nothing worked.
he takes brufin but it is also not very helpful

He should be on a combination of NSAIDs and muscle relaxants, ibuprofen + tizanidine or naproxen + tizanidine or even stronger medications like tramadol + naproxen or even a drug like Nuberol forte. The main thing here is to actually prevent the attacks from occurring in the first place, also ibuprofen is not the ideal drug to abort an acute attack of migraines, usually, we need medications like sumatriptan or zolmitriptan that I mentioned earlier.

Does he have a regular neurologist that he sees?

Customer: replied 9 months ago.
done three mri .been to neurologist they dont agree that cyst is the reason ,so they diagnose it is migraine . if it is cyst then situation could be worse.if migraine then should be go away after an attack.confusing.
but your suggestions r help full will discuss it .will try those medicine s as well .

If the neurologists have concurred that the cyst is not the cause then the migraine should be managed in a better manner. Daily attacks in migraines are simply not acceptable, yes the preventive medications take time to work, usually 2 weeks or so however in the meantime the pain management should be much better. If you have a large university hospital near you that would be the place to go, usually doctors from teaching hospitals are more up to date about the latest management trends on diseases.

Also, You're welcome, I hope I have earned a 5 star rating today, do remember to rate me by clicking on the stars above your screen as that is how we are compensated for helping you today. Any Bonuses would be well appreciated!

Customer: replied 9 months ago.
taking topiramate 50 mg (1+0+1)
indral 40 (2+0+2)

Ok so he is already on the maximum dose of topagen, then this means he needs to have the medications changed, especially if he has been taking topiramate for more than 2 weeks now.

Customer: replied 9 months ago.
doctor gave him that for two months .also he told me about botex but he said it could be the last option.if you think any other medicine could be helpful I will discuss that .

Valproic acid

Amitriptyline

Flunarizine

Calcium channel blockers

Acetazolamide

Gabapentin

Pregabelin

Ask him about these options and also, Transcranial magnetic stimulation or Transcutaneous supraorbital nerve stimulation, are other options which can be discussed with your neurologist. There are newer drugs like

Erenumab

Fremanezumab

Galcanezumab

which can be considered as well.

Would you like to know anything else? Any clarifications or additional questions that you might have, I would be happy to answer them for you. If done for now, please remember to leave a 5-star rating as that is the only way we are compensated for our time spent helping you. You can continue to ask follow-up questions even after the rating.

Dr. Muneeb Ali and 6 other Medical Specialists are ready to help you
Customer: replied 9 months ago.
at this moment I don't have any other question but may be later .5 stars is yours .thanks for giving your precious time.

You are more than welcome, best of luck.