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Meningeal Irritation treatment?
by: Hannah

We are curious about your description of meningeal irritation and how it might be treated. Our 8 year old daughter was diagnosed with viral meningitis (enterovirus) in 10/2010. She developed chronic persistent headaches after recovering which looked a lot like her meningitis symptoms (all over pain, varying levels of nausea, pain when spinning/turning her head). There appears to be two patterns to her headaches: The more intense one will appear suddenly and then will typically (not always) disappear within 5 minutes to a few hours with or without medication or other intervention; and the second is a baseline headache of grade 1-3/10 which is always present. Both are described as having 'all over' pain rather than any focal location. She has been diagnosed with migraines by a pediatric neurologist (not headache specialist), but she doesn't seem to fit the definition very well. The headaches, without medication, are fairly intense, often waking her at night and coming crying into our room, often involving nausea (this part sounds like migraines, we agree). However, she describes the pain as 'all over,' like what she experienced during her meningitis. Sleep does not make the headaches go away (and often began while asleep, prior to medication). Exercise does not exacerbate the condition, and has sometimes been useful in lessening it. Spins in ballet class are very painful (they did not hurt at all when she was in remission). She can induce a headache by holding her breath (as for hiccups), which resolves immediately when she breathes normally again. MRI venogram and CT scans of brain and sinuses were normal, and an optho neurology exam was normal. Nadolol provided no relief. Gabapentin alone improved symptoms, and combined with Topamax put her into remission for 3 months. In February 2013, another viral infection seemed to cause the headaches to return. Amatryptaline was added and helped for one week and then was no longer effective. Cyproheptadine was added and significantly lessened the frequency and intensity of the headaches, but they still occur and the constant 'baseline' headache (grade 1 to 3 out of 10) is still always present. And this is a LOT of medication for an 8 year old girl to be on (300mg gabapentin bid, 45 mg Topamax at night, 10 mg amatryptaline at night, 4 mg cyproheptadine bid). She had been prescribed maxalt as well, but didn't use it much except with a headache near bedtime (most of her intense headaches will resolve eventually without medication, and she has headaches so frequently during the day, it wasn't a very practical medicine to use).

Does this seem to fit the description of meningeal irritation? Or something else? Any suggestions on further treatment or diagnostic options? Thank you for your help!

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