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12 Y/O Daughter - Not getting relief

My daughter has been getting migraines since she was 7. She gets the headache along with nausea and vomiting as the worst of her symptoms. She is under the care of her pediatrician and has also seen a neurologist. We started a daily preventive of Amitryptaline about 4 months ago. She is taking 25 mg a day and uses Imitrex nasal spray for episodes. The daily just isn't working. Does anyone know if changing the dose to 50mg will have an impact or is it time to try a different one? I'm not sure how long to give the medication time to start having a significant impact on the frequency of migraine. We are treating about 2 headaches a week with Imitrex and using Advil on other days as we are trying to avoid any rebound headaches. I feel helpless at this point. She needs relief. She misses school and sports too much. Going to pediatrician tomorrow and will ask about the increase in dosage of Amitryptaline but still wonder if anyone on this forum could offer advice and support. I feel desparate.

  1. Ellen - Thank you so much for your response. The rebound headache cycle is so frustrating. the pediatrician said that alternating Advil with a triptan would help avoid MOH. I just hate the thought of a bad migraine and having to say... sorry you can't take anything and have to just get thru this one. I will pursue a headache specialist. I'm guessing they will up her does of elavil to 50mg and see if it helps. I'm trying to be patient and stay hopeful that something will eventually work. I spent alot of money at the chiropractor last year but ended up stopping because we just weren't getting results. I get migraines too so I understand her pain. I use Maxalt and it works great but she is only 12 and I've been told only Imitrex is available for her at that age. I'm glad your son has found a treatment plan that worked! Thank you again for your understanding. Your response was helpful and so appreciated.

    1. Is Summatriptan the only triptan approved for kids her age. She is now 12. I am paying just under $450 to fill the summatriptan nasal spray 5mg for (12) doses. I can't afford to keep paying that as she is using two a week! any suggestions? I think I'm going to try giving her excedrine migraine. Does this also cause MOH? Since it's acetaminifin and not ibuprofin I wasn't sure. Just wondering now that she is 12 if we have more options to try. Any advice or suggestions is welcome.

      Her daily med amatriptylene was increased to 50mg and hoping it reduces the frequency. Isn't two a week too many if you are on a daily preventive. Thank you!

      1. Hi lhwieghorst,

        YES - Excedrin can and often does cause medication overuse headache or rebound as does ibuprofen and acetaminophen.

        Only one migraine abortive medication is FDA approved for your daughters age group, Axert; https://migraine.com/migraine-treatment/axert/.

        Something everyone with migraine needs to do is learn what their migraine triggers are. No one wants or likes to keep a migraine diary especially children but it really is vital to a migraine management plan. Once we are able to identify some of our triggers we can try to avoid them. Then we may see a reduction in our migraine frequency and severity. I kept a migraine diary for my son when he was nine to figure out what his triggers were and we were able to determine that chocolate, nitrates, becoming dehydrated, skipping meals and changes in sleeping patterns were all strong migraine triggers for him. Let me share this information on triggers with you; https://migraine.com/blog/keeping-migraine-diary-basics/ and https://migraine.com/blog/migraine-management-essential-trigger-management/.

        I hope this helps,
        Nancy

        1. Thanks. I've kept many diaries for her and found triggers similiar like skipped meals and change in sleep patterns. I think the food and chocolate is tricky. We found those to be a possible trigger sometimes and other times nothing. We stay away from nitrates but chocolate is another story as it's her favorite treat. Can't totally take it out when it's not consistantly causing a problem.

          1. lhwieghorst@neair.com

            Here's the important thing to understand about triggers - they are cumulative. The analogy I use is kid's building blocks.

            Triggers are building blocks. Being exposed to them is like piling them into a tower. We all know that a building block tower can only get "so high" before it comes crashing down. That is a Migraine attack.

            Certain triggers are worth different numbers of blocks. The chocolate may be worth only two, while something else may be worth 5. Have only the 2 and they stack easily and won't fall down. But add them to the 5, and possibly others too, and your tower may get so high it falls down and *CRASH* you have a Migraine. This is one reason why identifying triggers is so tricky!

            ~Ellen

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