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Suffering From Headache, Nausea, Dizziness And Hypoglycemia. Over Sensitivity To Loud Noise. Diagnosed With Thornwaldt Cyst
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Thank you for sending your question.
Your question is a good one and I will work on providing you with some information and recommendations regarding the problems you are experiencing.
Regarding the over-sensitivity to normal environmental sounds I feel your child is suffering from Hyperacusis, which is a problem acquired as a result of damage sustained to the hearing apparatus, or inner ear which can happen infections, use of antibiotics and children with developmental delay.
Migraine headaches is relatively less common cause of hyperacusis and this usually happens at the time of headache. As her migraine is refractory to medications and not responding to Botox, I feel she needs a combination of medicines along with higher dose of Botox for control of headache. If there is any change in the character of the headache I would like to exclude other causes of headache in her.
Regarding the Thornwaldt cyst, is a common incidental midline nasopharyngeal mucosal cyst and is usually benign and asymptomatic. It needs treatment only when it causes pain and halitosis due to infection of the cyst. At present she does not require any treatment.
My recommendation would be for you to talk to your Neurologist about the treatment of migraine and to exclude other causes. At times more than one kind of headache can co-exists and needs additional evaluation and treatment. If she has responded to Botox earlier there us a chance she might respond to higher dosage. Though no relationship exists between migraine headache's and cortisol deficiency, You need to see your Endo to exclude this possibility.
I thank you again for submitting your question. I hope you have found my response to be helpful. If you have additional concerns I would be happy to discuss them with you.
Sincerely,
Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.
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Thanks for the follow up query
Regarding the cortisol, it can be primary or secondary. Primary means adrenal insufficiency due to impairment of the adrenal glands. Secondary adrenal insufficiency is caused by impairment of the pituitary gland or hypothalamus. Most common cause of adrenal insufficiency is exogenous steroid use.
Imaging of the pituitary gland and adrenal glands along with blood tests like serum cortisol, ACTH, aldosterone, renin, potassium and sodium are require to say if it is primary or secondary.
Regarding the Thornwaldt cyst, if it is infected and causing repeated problems we can consider the option of removing it. Do continue to treat the headaches and follow up with your Endo for detailed evaluation.
Wishing her good health.
Sincerely,
Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.
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