03 Sep Ask An Expert
Question: I am the mother of an 18-year-old daughter whose headaches have impacted her life for the last 5 years. I am writing because I feel helpless and hopeless.
There is a history of migraines on my side of the family. I had migraines, along with my mother and my grandmother. However, the migraines were linked to our menstrual cycles, migraines 3-4 days a month. Allie’s headaches certainly get worse around her period. Allie has a headache every day.
My daughter, Allie has experienced several sports-related concussions over the years. The last concussion was in September 2018 and Allie’s headaches got much worse. Allie has been seen by various doctors at a number of headache facilities and hospitals.
Over the last 5 years, we’ve tried various gluten-free and low sugar diets. We have gone to countless appointments for acupuncture, cupping, chiropractors, osteopath, massage therapy, ophthalmologist and pediatrician. Allie is on 30mg of Amitriptyline every day for the last 9 months. This medication cuts pain a bit but nothing dramatic. The last few months Allie has had two occipital nerve blocks and three weeks ago had Botox injections administered in the Boston Children’s Hospital OR. The nerve blocks and Botox have not helped her headaches.
Allie will be starting her freshman year in college next week, and as her mother, I have let her down. She feels there is no solution or help for daily headaches so she grins and bears it. Allie is otherwise a very happy, social, smart and loving young lady.
Answer: Headaches following a head injury are often labeled as “post-traumatic headaches” but this is not helpful to us when treating as there are so many structures in the head that can be producing pain. With a family history of migraine, she is probably one who has the genetics of migraine and the head injury is likely a trigger of the migraine becoming chronic
So we treat based on the description of the headache once obvious secondary causes have been excluded, generally with an MRI scan.
There are medications that have not been tried, but at this point in people having trouble getting relief we usually use the new drugs called “CGRP monoclonal antibodies” that might be useful. These are injectables but administered at home. A fair trial is monthly dosing for at least 3 months.
There are other migraine pills that can be tried at the same time, but it is difficult to be specific without knowing more details
Please visit the provider finder page if you need to find a headache specialist referral in your area.
Mark W. Green MD, FAAN
Director of Headache and Pain Medicine
Professor of Neurology, Anesthesiology, and Rehabilitation Medicine
Vice-Chair of Neurology for Professional Development and Alumni Relations
Icahn School of Medicine at Mt Sinai