Has Anyone Heard of This? - Hawthorne,CA

My 6year old daughter has the same headache/vomiting situation for about 2 years. We haven't had a MRI done, so I don't know about the issue with the carotid arteries. I have been researching and discussing with our pediatrician "cyclical vomiting syndrome". It is apparently common but often mis-diagnosed because people feel its a migraine or a gastro issue.

There are 2 basic treatments for it, one is a preventative migraine med given daily. Or an anti nausea med given when an episode starts.

It can range in intensity. My daughter tends to vomit just once, on some occasions a few times, and then will go right back to sleep within 30minutes. Other people I have read about will have vomiting lasting days and can end up in the hospital because of dehydration.

Each episode tends to be just like all the others. My daughter will wake from a dead sleep screaming about her head hurting, she will eventually vomit, and within 30 min is asleep again. The length of each episode tends to be how long she tosses and turns, waiting for it to get intense enough to make her vomit. Once she does, its immediate relief. They used to happen every 2 weeks or so but we have managed to identify a couple of triggers and have pushed it to once a month.

It helps if you can find triggers (like you would for a migraine) and try to head those off. For my daughter her triggers are tiredness/fatigue, low blood sugar (if for some reason we are getting dinner way later than usual), and dehydration from over exertion.

A good neurologist is the way to go and they will be familiar with the Cyclical Vomiting Syndrome as well as the issue with the carotid.

I will be adding a MRI to our to do list.

Well, there are 3 different carotids, the external, internal and common - It is incredibly rare to be missing such an amazingly important artery, but the good thing is there are 3 of them, so the other two will take the place of the missing one.
I am sure the doctor can tell you which carotid set is missing, and give you more info

I have never heard of it, but I am not a doctor. Wouldn't they see this during an ultra sound? I It seems like it could be something that is extremely rare.

Haven't heard of that specifically, but missing or reversed organs do happen. I knew a kid who'd apparently been born with one kidney once.

Since the child is 5, it would seem that other blood vessels to her head have somehow taken over the job of the carotids.

Hi A.,

Neurology isn't my field, but a quick search of PubMed (the NIH library) revealed that this is a rare condition that can be associated with severe headaches and other possible problems. According to the abstract below, it's usually not discovered until adulthood. BTW, if you want to get a copy of this paper, you can download it from the publisher (Wiley: probably cost is $35), or you can go to a university medical library and copy it for a lot less (UCLA charges, I think, $0.11/page for nonstudents these days). Agenesis means that something never forms or develops.

J Paediatr Child Health. 2008 Sep;44(9):511-3.
Bilateral agenesis of the internal carotid artery: case report and approach to management.
Steer AC, Rowe PW.
SourceDepartment of Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia.

Abstract
We present the case of a 13-year-old boy who presented with two episodes of acute onset severe headache. Initial investigation with computerised tomography revealed no apparent abnormality. Magnetic resonance imaging and magnetic resonance angiography revealed that this boy had absence of both internal carotid arteries bilaterally. Absence of the internal carotid arteries is an uncommon condition, but does occur with unilateral absence being more common than bilateral absence. The condition is usually diagnosed in adulthood but may be diagnosed incidentally in childhood. When diagnosed in childhood, the main aim of management is to prevent the development of cerebrovascular accidents.

PMID:18928467

I noticed another abstract (published by Springer Verlag, so also probably costs about $35) that suggests that the normal blood flow is usually redirected through alternative routes if the carotid doesn't develop properly, suggesting that this is not necessarily a major problem, and that it could, depending on the circumstances, be considered a normal variant that requires no specific treatment:

Anat Clin. 1984;6(2):133-41.
Segmental agenesis of the internal carotid artery: angiographic aspects with embryological discussion.
Lasjaunias P, Santoyo-Vazquez A.
Abstract
The embryology of the internal carotid artery (ICA) shows that this vessel comprises from origin to termination six segments, i.e. cervical, petrous, vertical cavernous, horizontal cavernous, clinoid and cisternal segments. Each of these segments displays a specific course and limits, defined by the origin of the following embryonic arteries: ventral pharyngeal hyoid, mandibular, primitive maxillary, trigeminal, dorsal ophthalmic and ventral ophthalmic. Each segment is independent and may show agenesis. In such cases the internal carotid blood flow (hemispheric arterial supply) is rerouted to afford usual ICA supply distal to the agenetic segment. All congenital anomalies of the ICA can be described and understood on the basis of embryological data. The "aberrant internal carotid" can therefore be identified as a normal vessel. Differentiation can be made between congenital versus acquired absence of the ICA. This type of analysis should allow the clinician to recognize what are normal, albeit rare variations, rather than to mistake them for an abnormal condition requiring treatment.

PMID:###-###-####

I hope all goes well for the child. Migraines may be linked to restricted blood flow in the brain, thus drugs like caffeine, which are vasodilators (expand blood vessels) can sometimes help. There are medications available that a neurologist might prescribe. My daughter has migraines, and her neurologist suggested using Petadolex, a natural product derived from butterburr. While this doesn't require a prescription, I wouldn't recommend it to the family unless the doctor does. BTW, it wasn't helpful for my daughter.