Feeling Tired, Getting Headache And Nosebleed. Taking Promethazine. MRI Normal. Should I Visit ER?

Posted on Thu, 21 Mar 2013

Question: My 11 yr old daughter has had a stabbing pain headache on top of her head for 13 days. the pain is worse when she wakes up. she also says she is very tired. Today on the 13th day she had a nosebleed for about 5 minutes. She has been taking promethazine for 6 days (1 12.5mg tablet 4 x a day) along with childrens tylenol and motrin every 6 hrs. I stopped the tylenol and motrin as her stomach is bothered by this now. She had an MRI this week and it came back normal. We have a follow up with her pediatrician tomorrow. As of yet he is not concerned much and is a very booked , busy Dr. Should I make an apt. with a neurologist given the MRI is normal?

Answered by Dr. Samik Basu (22 minutes later)

Hi ,
Thank you for your query.
I can understand your concern
I would like to have her blood pressure checked and would like to have her sinuses checked.
A normal MRI excludes anatomical abnormalities.But it does not exclude vascular causes.
Migraine and sinusitis can have severe headaches but usually do not cause nasal bleeds.
I think a neurological opinion is warranted.
NF1 usually does not cause headaches unless associated with increased intracranial pressure or hypertension.
If you have any further queries you are free to consult me.
Hope this answers your query.
Wishing a speedy recovery.
Have a nice day.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Samik Basu (23 hours later)

Thank you for your reply. Her blood pressure is in the normal range I am told. We saw her pediatrician today. He said her sinus were clear on the MRI. He wasn't going to suggest anything further and told us that given the area of the headache (top of head and duration and the fact that she wasn't crying about the pain and her body didn't show signs of distress from being in pain in his office) he wouldn't recommend anything further. In so many words he said it was "in her head". All he have pursued is an MRI. The headache/neurologist needs a referral from our pediatrician to see her. At this point I am afraid to call him. Do you recommend just getting a new pediatrician at this point or should I demand a referral. I guess my question is ,is it possible to have a stabbing headache at the top of your head that is tolerable most of the day but painful when waking from sleep or when active. She has mentioned that she can't breath through her nose when she lays flat to sleep. I also mentioned this. He had no suggestions on that. We don't see our Dr. often and I am really afraid to purse this further with him as he was quite dismissive to her today. Was he correct to suggest this was all in her head? If I thought this pain was non existent I would be the first to make an apt. with a psychologist.

Answered by Dr. Samik Basu (17 hours later)

Hi,
I really can understand your dilemma.
All I can suggest is that you get your child reviewed by a neurologist.
If he suggests that she needs counselling by a psychologist then go for it.
Psychological causes should be thought of when all the causes for headache has been excluded.
Best of luck..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar