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Dr hive - ocular migraines, cluster migraines in teens??? Medications?

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DS 14. Has worn glasses since he was 4. Stopped needing them last year at 13. The last six months or so, he's needed them to read.


Fast forward. He says the last few months his eyes have been having to work harder to see.


The last week, he's been having ocular migraines every day. After ocular symptoms, he has massive headache and is lost the entire day. On Friday, he had two. His doctor put him on Sumatriptan at the first sign of ocular migraine. He also said that ds had a, "Less distinct disc margin in left eye."


The medication is working! Ds has taken it (nasal spray) at the first sign of an ocular migraine and it is gone. No headache. No tiredness the rest of the day! Yeah! He is also wearing his glasses again and finding it easier to see during the day.


We have an appointment with his opthamologist on Thursday.


Anyone recognize these symptoms? Familiar with the medications? What does"less distinct disc margin in left eye?" mean? Any other ideas? Questions I should ask the eye doc?


Should I insist on a scan of some sort?


I'm so confused!!!

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Not a doctor, but I do have nursing experience and a history of cluster headaches and migraines myself.


This is definitely NOT a cluster headache. Those last less than 2 hours and are the worst pain it is possible to feel. They very well may be migraines of some type.


Typically neurologists treat migraines, not eye doctors. It could be the headaches are not migraines at all, but are caused by an eye problem. Or he could have both a vision issue and migraines.


He needs an MRI with and without contrast and a CT scan to make sure his brain is normal. I would also have his vitamin D levels checked, and would supplement with a high dose of D3 if the level is low. By high dose I mean 5,000-10,000 IU per day, with a blood test done every 3 months to make sure the levels are correct.


With teens, medication for migraine often means some caffeine, such as a Mountain Dew or a Red Bull at the first hint of a symptom, and combine it with Advil until the child is past the age where Aspirin would be dangerous, and then switching to something like Excedrin. I would hesitate to use triptans like Imotrex or the like on a child because there are serotonin receptors throughout the body and we don't know what effect that might have on a growing child. Also, triptans tend to cause rebound headaches, which are not worth it.


Migraines typically have a lot of dietary triggers. If it's determined an eye problem is not the cause of this, you should probably spend some time on the American Headache Society website to learn more: http://www.achenet.org/


Also, find him a neurologist that is a headache specialist.

Edited by Katy
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I have chronic migraines and my husband has cluster headaches. All 6 of my kids get migraines, several of them starting as young as 4 or 5. I agree with a pp that what you describe does not sound like a classic cluster headache.


My 14 year old will be seeing a neurologist soon so she can get started on migraine prophylactic. I've been warned that he will probably order scans 'because of her age' although given her history, no one doubts she presents with migraines. So, I suspect you might be sent for scans whether you want them or not.


Triptans....my salvation!!!! I have been taking them since they first appeared on the market back when they were injected. My older daughter has no luck with 'triptans but I live on them. Seriously, there are months where I will need one (sometimes 2) a day.


I have noticed no long term side effects and although, there are times when, soon after taking then, I have some uncomfortable effects as the meds start to work. Not always - just sometimes. I describe it as 'bugs crawling through my brain'


I, personally, would have no problem letting my 14 year old try them if they were prescribed. It doesn't always work, even for me, but when it does it makes my life livable.


I hope you have continued success with treating your son. Migraines are miserable and can control your life. You have a wonderful start in finding a doctor who will treat your son. My experience with several of my older kids is that many doctors tend to dismiss them in children with a 'take an ibuprofen and a nap and you'll be fine.'

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