Dr. Raquelle Bernier of the Children’s National Headache Clinic is one of my favorite physicians ever. She has the presence and demeanor of a kindergarten teacher (i.e., everyone wants to be friends with her), but is also one of the most technically competent physicians I’ve ever met. She made a point of double-checking Christopher’s MRI after we told her about the newly diagnosed arteriovenous malformation (AVM) and agreed that it was there and needed to be checked out. She also agreed with the ophthalmologist that Christopher was having migraines with auras. After taking a very thorough history, she told us that headache specialists are starting to see a pattern wherein kids with migraine diagnoses have a history of colic as infants, digestive upset (abdominal migraine), and extreme, early onset motion sickness. They believe these aren’t separate issues, but rather, an indication that the pediatric brain is very different than the adult brain, and experiences pain much differently. So it wasn’t that our perfectly normal child suddenly started experiencing blistering headaches at 9 years of age. It was that he’d been symptomatic from the Chiari (and possibly the AVM) from birth, it was just at age 9 that he started experiencing those symptoms in a way that led to a brain MRI and proper diagnosis. That, she said, was why we'd noticed the abdominal migraines (vomiting, nausea, diarrhea, stomach cramping) fading away as the more classical migraines with auras kicked in.
More importantly for Christopher, though, she put him on 10mg amitriptyline as a daily headache preventative and wrote out an extensive treatment plan that included dietary, water, exercise, and sleep components to keep the headaches at bay. Because the AVM presents a stroke risk, NSAIDS and triptans are verboten, but occasional Tylenol is allowed. She also asked that he stay away from rollercoasters and contact sports, I presume because he has enough issues without adding a concussion into the mix.
For more information on what the medical community now knows about Pediatric Headaches, please follow the link below. If this had been known a decade ago, Christopher would have had a brain MRI by his first birthday. Not only was he the colicky baby to end all colicky babies, the colic extended well beyond the normal first three months of his life. By five months, he was diagnosed as failure to thrive because I couldn't keep milk in him. No matter how gingerly I raised him to a vertical position after feeding, as soon as he was fully upright, he'd projectile vomit everything in his belly, and continue for hours. As for motion sickness....I could have set a timer for him puking 20 minutes after getting in a car. By the time he was 8 months old, the pediatrician recommended I put Baby Einsteins on loop in front of his rear-facing carseat on even a short trip to the grocery store so that I wasn't always driving distracted from the crying. He had his own Zofran prescription for car, plane, and train rides at his second birthday because Dramamine wasn't effective. This was the pattern that emerged from Dr. Bernier's questioning, which is corroborated by this summary from the Michigan Headache & Neurological Institute.
http://www.mhni.com/headache-pain-faq/pediatric-headaches
For more information on what the medical community now knows about Pediatric Headaches, please follow the link below. If this had been known a decade ago, Christopher would have had a brain MRI by his first birthday. Not only was he the colicky baby to end all colicky babies, the colic extended well beyond the normal first three months of his life. By five months, he was diagnosed as failure to thrive because I couldn't keep milk in him. No matter how gingerly I raised him to a vertical position after feeding, as soon as he was fully upright, he'd projectile vomit everything in his belly, and continue for hours. As for motion sickness....I could have set a timer for him puking 20 minutes after getting in a car. By the time he was 8 months old, the pediatrician recommended I put Baby Einsteins on loop in front of his rear-facing carseat on even a short trip to the grocery store so that I wasn't always driving distracted from the crying. He had his own Zofran prescription for car, plane, and train rides at his second birthday because Dramamine wasn't effective. This was the pattern that emerged from Dr. Bernier's questioning, which is corroborated by this summary from the Michigan Headache & Neurological Institute.
http://www.mhni.com/headache-pain-faq/pediatric-headaches
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