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Medications & Prescription Treatment

12 Y/O Daughter – Not getting relief

  • By VTLauren

    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.

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  • By VTLauren

    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.

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  • By VTLauren

    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!

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  • By Nancy Harris Bonk Moderator

    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

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  • By VTLauren

    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.

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    • By Ellen Schnakenberg

      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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  • By VTLauren

    Yes that makes sense about the building blocks. My husband and I can tell her a million times to please drink water during the day and make sure you eat your lunch and snacks. We are always stressed when she leaves for a sleepover b/c we know it will catch up with her in a day or two. But she needs to live her life. We cannot deny her spending the night with friends b/c she “might” get a migraine. that isn’t fair. We’re not with her all day at school and so can’t remind her constantly to drink water and eat food. She’s a kid and would forget her head if it wasn’t attached. Maybe as she gets older she’ll be a better advocate for herself and take the triggers more seriously. I really appreciate your comments. Thank you.

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  • By VTLauren

    I wanted to give an update. My daughter went up to 50mg of amatriptylene and it has made a difference. We also got very strict in adhering to only twice a week of imitrex. She went three weeks without imitrex or advil!! This is so huge for us. After about 3 weeks of nothing she did experience a migraine but seemed to recover okay the next day. She did use one imitrex. I think we finally broke the chronic everyday cycle of headache for her. I can’t put into words how happy we feel to see her finally get some relief from the chronic pain.

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    • By Nancy Harris Bonk Moderator

      Hi lhwieghorst,

      I am so happy to hear this. Your entire family must be thrilled to see an improvement in your daughter. As we know migraine can impact the entire family.I am so happy to hear this.

      I’ll be keeping my fingers crossed for her continued success.

      Nancy

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  • By Ellen Schnakenberg

    lhwieghorst

    First, I am so sorry you are struggling so with your daughter’s situation. I do understand it though. My son was diagnosed as an infant, and my daughter at about your daughter’s age.

    My son had wonderful results from periactin, which is often used in peds patients quite effectively. It might be worth a try. In our case, he didn’t have the same results from the generic, although there’s no way to know how your daughter might react. He was chronic by age 4, but we got him back to an episodic pattern that was liveable and he has not yet become chronic again as a result of managing everything very carefully. He will be 29 in a few weeks. So, there is hope 🙂

    I know it seems like seeing a neurologist would be the very best place for your daughter, however, the fact is that there are Migraine and headache specialists that are changing people’s lives every day. Here is a link that you can use to find the specialist nearest you: https://migraine.com/blog/looking-for-a-migraine-specialist/

    Mixing your triptans with Advil will not protect your daughter from MOH. It’s unfortunate, but the meds that can cause MOH are cumulative together. Taking 3 different meds for 2 days each, is the same as taking one med for 6 days. We want to keep the use of those meds to no more than 3 times per week.

    There are many different triptans, and I’m wondering if she’s ever tried another triptan to see if it might be more helpful? Frova is the most long acting, however it is expensive and takes a bit longer to be effective. Sumatriptan injection is the fastest to go to work, but doesn’t last long.

    This is one place where seeing a Migraine specialist would be very helpful for you IMHO.

    Preventives for kids are not well studied, and doctors often go for the least of the meds as possible. Amitryptaline is one that is often used. It isn’t a slam dunk for effectiveness though. There are so many preventives that it would take 25 years to try them all, and then many patients do the best on multiple meds together… so there is still a lot of hope out there.

    ~Ellen

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