David’s story: When behavior was really a migraine

Every morning at 5 a.m., Ellen prepares her 12-year-old grandson David’s prescribed medications, carefully grinding them so he can take them safely. She repeats the process two more times throughout the day as part of a routine she’s followed for years.

“David isn’t able to swallow pills. Over time, I’ve learned how important consistency and routine are for him,” Ellen says. “Not missing a dose of medication is especially important for highly autistic kids.”

Ellen is David’s 68-year-old grandma. She’s adopted David and has been caring for him ever since Ellen’s daughter died unexpectedly when David was just one-and-a-half years old.

“I miss my daughter so much and David looks just like her – and I love him so much,” Ellen says.

Uncharacteristic aggression

When David was around 10 years old, Ellen noticed that he seemed more agitated and aggressive than usual. She was desperate to find relief, and better answers for David’s behavior.

“I was referred to a psychiatric clinic. But they prescribed anti-psychotic medicines that were making him more aggressive,” says Ellen.

David was doing a lot of self-injury and biting others and himself. He was covered in red and purple and green bruises. His teachers needed to wear protective gear.

“It was the worst he’d ever been,’” Ellen says. She remembers thinking that he had to be in pain to be hurting himself and others so badly.

Ellen knew there was a history of migraines on both sides of the family. But Ellen couldn’t ask David if his head hurt, or if he felt dizzy or nauseous, because David is non-verbal.

“No doctor had brought up migraines before. And they’re just one of those things that if someone doesn’t tell you their head hurts, you can’t guess by just looking at them,” she says.

Deciding to see a neurologist

One day, at a gastroenterologist appointment for David’s chronic constipation, Ellen started chatting with a social worker. She encouraged Ellen to consider taking David to see a neurologist.

“She told me that there are so many different things that can happen with autism, so many co-morbidities that sometimes only a neurologist can figure out,” says Ellen.

The next day, Ellen made an appointment with Ishani Kumar, M.D., Pediatric Neurologist at Children’s Health℠ and Assistant Professor at UT Southwestern.

Asking the right questions

Ellen liked Dr. Kumar from the moment she met her. She listened closely and asked a lot of detailed questions. She also reassured Ellen that she would help parse out David’s symptoms and behaviors – and make sure any medications he was taking were both necessary and helpful.

“Signs, symptoms and triggers of migraines can vary a lot in children. And it's typically even more challenging to know if a child is experiencing migraines when they’re nonverbal,” says Dr. Kumar.

Ellen explained to Dr. Kumar that David had been holding his stomach and bending over, and experiencing goosebumps, gagging, vomiting and yawning – all possible symptoms of migraines. David also really wanted to be left alone and was reacting even more strongly to loud noises.

But one of the biggest clues that David might be having migraines came from his family history: his mom had terrible migraines as a child and an adult, and David’s aunt and grandfather also suffered from migraines.

A night-and-day difference

Dr. Kumar prescribed a medication that’s commonly used to treat migraines in kids. Even at a low dose, it seemed to help with stomach pain. Given this improvement, Dr. Kumar also decided to prescribe a “rescue medicine” for David – to be used when it seemed migraine pain was extra intense.

“Rescue medicines are designed to work immediately, within 30 minutes. And they only treat migraine pain,” says Dr. Kumar. “I knew that if David’s symptoms were just behavioral, a rescue medicine would not help them.”

After giving David the rescue medicine, Ellen noticed a night-and-day difference.

Dr. Kumar also witnessed this transformation. “After taking rescue medication, the David that would sometimes try to bite our medical assistants was suddenly happy and hugging everyone in the room.”

Now convinced that David was having migraines, Dr. Kumar went on to prescribe a beta blocker medicine for him.

“I put David on the very same beta blocker his mom used to take as a child for her migraines – and he’s been a different person ever since,” says Dr. Kumar. “I don’t see bruises or bite marks on Ellen’s arms anymore. David is a lot more loving – and even more verbal. I’ve heard him say more words than ever before since he started taking a beta blocker.”

Reviewing all his medications

Ellen appreciates that Dr. Kumar was methodical – and cautious and persistent in her questions, diagnostics, and the medications she prescribed.

“I always start each new medication at the lowest possible therapeutic dose and give each one several weeks to take effect,” says Dr. Kumar. “I knew that the last thing Ellen and David needed were more medications that didn’t work – or that caused paradoxical reactions that are the exact opposite of their intended effect.”

After seeing David regularly for several months, Dr. Kumar was able to get him on a combination of medications that yielded game-changing results – and help him wean off other medications that were not benefitting him.

She also helped refer David to Children’s Health pediatric neurodevelopmental disabilities (NDD) clinic[CC1] , where he can receive applied behavioral analysis (ABA) therapy, a type of therapy designed to improve behavior and social and communication skills for autistic kids and their families.

A return to David’s “loving” self

Given how much better David is doing, he only needs to see Dr. Kumar every few months now, especially since he now has a clear rescue plan in place.

When asked why she chose to share her story, Ellen had a one-sentence answer: “I just love Dr. Kumar. I can’t say enough good things about her and how helpful she has been.”

Dr. Kumar helped set Ellen and David on a manageable path forward and she will be forever grateful.

“I knew that underneath all of David’s aggression was still a really loving child. And I’m so glad to have that child back,” says Ellen.

Learn more

Learn more about migraines in children or about our team of compassionate neurologists who offer expert, individualized support and care for migraines at our headache clinic.