Headaches in a 15-Year-Old and Incidental Unruptured Aneurysm
Headaches in a 15-Year-Old and Incidental Unruptured Aneurysm
The patient was seen again in the pediatric neurology clinic after the neurosurgical consultations and recommendation for serial MRI/MRAs. Her headache pattern was generally unchanged from prior assessments, and headache hygiene remained poor. The family was given a headache diary again and instructed to keep track of potential environmental or other triggers. The family preferred to pursue lifestyle management over prophylactic treatment at present, although daily prophylactic treatment would be indicated based on the character and frequency of the headaches. She would continue to use acetaminophen as needed for more severe headaches; with this drug taken as soon as possible after headache onset for maximum effect. Additionally, the family verbalized understanding of the importance of regular exercise as a nonpharmacologic method of headache management and that exercise needed to be of sufficient intensity to cause sweating and an increased heart rate.
Because she would be working to improve headache hygiene in general and specifically sleep hygiene, a trial of melatonin 3 mg at bedtime was recommended to make her sleep onset more effective. In addition, she would try taking vitamin B2, 200 to 400 mg (riboflavin) daily for headache prophylaxis prior to starting a prescription medication. The B vitamins help the body convert food (carbohydrates) into fuel (glucose). The exact mechanism of headache relief from riboflavin is not known.
Third Visit and Case Outcome to Date
The patient was seen again in the pediatric neurology clinic after the neurosurgical consultations and recommendation for serial MRI/MRAs. Her headache pattern was generally unchanged from prior assessments, and headache hygiene remained poor. The family was given a headache diary again and instructed to keep track of potential environmental or other triggers. The family preferred to pursue lifestyle management over prophylactic treatment at present, although daily prophylactic treatment would be indicated based on the character and frequency of the headaches. She would continue to use acetaminophen as needed for more severe headaches; with this drug taken as soon as possible after headache onset for maximum effect. Additionally, the family verbalized understanding of the importance of regular exercise as a nonpharmacologic method of headache management and that exercise needed to be of sufficient intensity to cause sweating and an increased heart rate.
Because she would be working to improve headache hygiene in general and specifically sleep hygiene, a trial of melatonin 3 mg at bedtime was recommended to make her sleep onset more effective. In addition, she would try taking vitamin B2, 200 to 400 mg (riboflavin) daily for headache prophylaxis prior to starting a prescription medication. The B vitamins help the body convert food (carbohydrates) into fuel (glucose). The exact mechanism of headache relief from riboflavin is not known.
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