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Suggest Treatment For Severe Headache, Nausea And Dizziness

Posted on Sat, 27 Dec 2014

Question: My 12 year old daughter has been having a severe headache that never goes away, nausea and dizziness and sleeping 18-20 per day. The symptoms have lasted one month. We have seen our pediatrician, a neurologist and an ENT specialist. She did a round of methylprednisolone 4 mg after week two. They have also perscribed Ondansetron HCL 4 mg for nausea and meclizine 25 mg for dizziness. We have had an EEG which was normal.

Answered by Dr. Sumanth Amperayani (50 minutes later)

Brief Answer:
Could be a migraine or an ADEM

Detailed Answer:
Hi...by what you quote I feel this could be a migraine or an ADEM - Acute disseminated encephalomyelitis.. Other possibility is a slow virus or prion disease.

If I were you pediatrician - I would prefer to do an MRI brain and an ophthalmological evaluation with fundoscopy and go ahead.

I would like to know why steroids were started - with what dfferential diagnosis.

Regards - Dr. Sumanth

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

Follow up: Dr. Sumanth Amperayani (37 minutes later)

The Doctors thought possibly mononucleosis but after blood work she tested negative. Also all other blood work normal. The doctors that we have seen do not feel is is a migraine because she has had it non stop for over 30 days. Do you feel that is possible? We are scheduled for a audiological evaluation, full vestibular and balance evaluation and videonystagmography.

Answered by Dr. Sumanth Amperayani (2 hours later)

Brief Answer:
The other possibilities I suggested to be ruled out

Detailed Answer:
Hi...Your doctors may be right. Continuous headache may not be migraine. But cannot be ruled out completely.
At the same time - I am glad that mononucleosis has been ruled out but what I suggested was different - ADEM and Prion diseases are different from Mononucleosis.

Other possibility is benign intracranial hypertension.

This is the reason why I am suggesting to take an MRI brain - But as you as it is normal. I am glad.

But the possibility of Prion diseases still exists - that has to be ruled out by a Cerebrospinal fluid analysis after alumbar puncture.

But most common things 1st - Migraine even now I would put at the top of diagnosis - as MRI is normal.

I suggest getting an ophthalmological evaluation to look at the optic disc in fundoscopy. if it s bulging or edematous - we need to think about benign intracranial hypertension.

Regards - Dr. Sumanth

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

Follow up: Dr. Sumanth Amperayani (7 hours later)

Thank you for your suggestions. I think if the tests today are negative as the ENT doctor thinks we are going to have a lumbar puncture and MRI on Wednesday. I will ask about the ophthalmology evaluation next.

Kindly,
XXXXXXX XXXXXX

Answered by Dr. Sumanth Amperayani (6 minutes later)

Brief Answer:
I will be happy if my suggestions make her well

Detailed Answer:
Hi...I will be extremely happy if my suggestions relieve her off the pain.

If you are happy with my interaction kindly rate it. At the same time I will be curious to know what is the ultimate diagnosis. If you can, kindly update me about the proceedings.

Regards - Dr. Sumanth

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

Follow up: Dr. Sumanth Amperayani (28 hours later)

Dear Dr. XXXXXXX

All balance tests yesterday were normal no inner ear problems. Waiting to hear from Neurologist regarding plan for MRI and lumbar puncture.

I will let you know how things go.

Thanks.
XXXXXXX XXXXXX

Answered by Dr. Sumanth Amperayani (7 hours later)

Brief Answer:
Hopefully it should be a Migraine

Detailed Answer:
Hi XXXXXXX I am glad that all the test have come back as normal. Hopefully I think it should only be a migraine which is bothering. usually kids grow out of it. Please do not worry and keep me posted.
Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Shanthi.E