What Causes Intermittent Headache, Chronic Migraine, Vision Distortion And Fever?

Brief Answer:
Your son may be suffering from micropsia

Detailed Answer:
Good afternoon. I am a headache specialist and adult neurologist. I also treat pediatric headache patients down to about 5-6 years old so let me assure you that your son's problem is not unique though I'm sure you find it a bit strange to say the left. He sounds as if he is suffering from a visual distortion condition called MICROPSIA. Does the visual distortion seem to occur during his episodes of headaches? Has he been diagnosed with migraine headaches?

One of the first things to do whenever anybody complains of this type of phenomenon is to have an expert such as an ophthalmologist look at the eye and especially the retina and internal architecture of the eye. Visual distortions of this nature can come about through defects in the retina, corneal thickening, changes in the vitreous of the eye, macular swelling and edema as well swelling of the retina....and especially if his has some type of viral infection I'd like to know if that has affected the brain at all...or potentially the eye.

That's why I think that in the face of a viral infection with fever that there be an ophthalmological examination to really get a good look at the internal structure of the eyes. If you do take him the ophthalmologist (and notice I said OPHTHALMOLOGIST and NOT OPTOMETRIST....for something like this we don't want to miss a diagnosis if present) make sure he is tested with an Amsler grid since in micropsias those can look highly distorted to the patient and especially in the central portion of the grid.

Migraines in and of themselves can produce MICROPSIA as a symptom and so you should definitely keep track of when he has the episodes of seeing things smaller than normal and correlated that to his headaches. He may also report seeing this phenomenon when focusing on objects extremely close to the eye itself whereas focusing at a normal distance tends to make things normal.

There is a particular virus that is highly associated with the condition of MICROPSIA and that would be the Epstein-Barr virus which he could very well have if his episodes of visual distortion are not necessarily in conjunction with headaches...but 9 times out of 10 they actually are so please get a down and dirty history from him...and remember, at age 6 he is not going to volunteer a whole of information. You have to really pry for some of the information because he may not know how to express it adequately.

Brain lesions themselves could also cause this to occur and so if your son's fever has been particularly high or present for a long time then, there is a chance that an area of the brain may have been affected. I think it a bit unlikely given your reference to the fact that he seems to be otherwise normal. But nevertheless one should check all possibilities.

One other caveat to keep in mind with micropsia is that certain seizure disorders could cause this phenomenon. Again, probably less likely in your son if he is "otherwise fine" but just so you are aware patients with epilepsy as the progenitor of the visual distortion don't have to be convulsing all over the place...it can be rather subtle and almost imperceptible since aside from the visual distortion patients' mental statuses do not necessarily alter to any significant extent, nor are they jerking their limbs, biting their tongues, or any of the other symptoms one would see in a seizure.

Nonetheless, a quick EEG...especially if he can be caught having one of the micropsia episodes could be worth a million bucks to the diagnosis. There are EEG machines that can be attached and taken home to run for up to 72-96 hrs. at a time while the patient keeps a continuous cap on their head. In school age children I always allow them to worry it home starting Friday evening and that way they don't have to go out anywhere if they may feel self conscious with the cap on the head and wires going to a belt clipped box.

If there is going to be anything on EEG it would most likely show up in the temporal lobes and if something does show up there please make sure your son gets an MRI of the brain with gadolinium contrast as they look for something called mesial temporal sclerosis.

I hope these suggestions satisfactorily address your question and give some additional information you can discuss with your doctor for how to attack this problem. If so, may I ask your favor of a HIGH STAR RATING with some written feedback?

Also, if there are no other comments, may I ask you not forget to CLOSE THE QUERY on your end so the question can be transacted and archived for further reference by colleagues as necessary?

You are invited to direct more comments or inquiries to me in the future by going to my web address at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.

The query has required a total of 35 minutes of physician specific time to read, research, and compile a return envoy to the patient.

---

Brief Answer:
And there you have it!

Detailed Answer:
As the old saying goes.....if it sounds like hooves pounding the ground then, they're probable horses and not zebras! Perhaps, if we lived in Australia that saying would be different! Well, glad things worked out and the diagnosis was I'd suspected.

I am happy to be your sounding board in the future if need be as I do treat pediatric headaches as well. I would clearly make one recommendation and that is to find at least a HEADACHE SPECIALIST if not a PEDIATRIC HEADACHE SPECIALIST. You probably will attest to the fact that the faster these can be brought under tight control the more likely he is to respond to simple treatments rather than going round and round with things that don't work and then, finding out a couple of years from now that his headaches are more difficult or even refractory than before.

Lots of luck with everything and don't forget...anything else that I can help you with- please toss me a line at: bit.ly/drdariushsaghafi

May I ask your favor of a HIGH STAR RATING with some written feedback if your questions were satisfactorily attended to during our transaction?

Also, if there are no other comments or questions, may I ask you to CLOSE THE QUERY on your end so things can be transacted and archived for further reference by colleagues as necessary?

Please keep me informed as to your son's progress with his headaches.

The query has required a total of 44 minutes of physician specific time to read, research, and compile a return envoy to the patient.

---

Brief Answer:
Are you willing to travel a little farther East than the Windy City?

Detailed Answer:
I know a great neurologist who is only 6 hrs. East of Chi-town, treats pediatric patients even though he's primarily an adult neurologist? He even gives his pediatric patients SOME OF HIS OWN GUMMY WORMS to well behaved kids!

LOL......I won't be hurt if you say "no".....but you'd only be passing up on Gummies for yourself as well! I reward parents who have well behaved kids! LOL.....

There is the Seymor XXXXXXX Headache Clinic in XXXXXXX and they are very well respected.

And then, there's Parma Neurology in Parma, Ohio and both the clinic as well doctor are well known for their 3 lb. bags of Gummy Bears which they share (but mostly eat themselves!!) which have been known to be emptied during normal business hours in the office! LOL!

Please be SUPER CAREFUL with Motrin....Greater than 15 days per month of use of this medication (some people even say 15 DOSES as maximum) can result in about 30-40% of people suffering from what we now call MEDICATION OVERUSE HEADACHE....very difficult to treat and overall does build up, what one would expect when literally hooked onto something...., the hangover effect!

We've got Cedar Point as well which your son will go crazy for---GUARANTEED.....!

May I ask your favor of a HIGH STAR RATING with some written feedback if your questions were satisfactorily attended to during our transaction?

Also, if there are no other comments or questions, may I ask you to CLOSE THE QUERY on your end so things can be transacted and archived for further reference by colleagues as necessary?

Please keep me informed as to your son's progress with his headaches.

The query has required a total of 71 minutes of physician specific time to read, research, and compile a return envoy to the patient.

---