Q. . Is there any relationship to severe ongoing headaches and BPD? My 15 yr. old daughter, who also has Type I diabetes, was diagnosed with BPD. Her diabetes is amazingly in very good control. Her Hemoglobin A1C is in the 7's. She has seen a neurologist who can find nothing in her MRI & MRA and after giving her large doses of Neurontin, along with increasing her Celexa from 30mg to 40 referred us to a psychiatrist. In a neuropsychological evaluation 2 years ago she was diagnosed with BPD. I realize that is a matter of trial and error in finding medications that work. Right now she is taking 60mg Celexa, trileptal 600mg am & pm, Remeron 15mg at bedtime, Seroquel 25 mg morning and afternoon and 100mg at bedtime, all prescribed by her psychiatrist. Since the Remeron was added she has been able to sleep at night. However, the headaches remain. We are seeing the psychiatrist on a weekly basis in an attempt to adjust the meds to give her some relief, as well as her therapist. Do you have any suggestions? At the present she is unable to attend school and it is going on 4 months now. She has tried many different antidepressants including Effexor (which was changed after a suicide attempt in 12/99) Zoloft, Prozac and Imipramine (sic). Depakote and Neurontin were also unsuccessful, in combination with Celexa.

  A. Headaches are very common with BPD as are migraines, irritable bowel, TMJ, PMS, and Fibromyalgia. I have had little luck in BPD + headaches with Celexa doses below 80 mg/day. Effexor XR is best at 300 to 450 mg/day, and Serzone (if she is not obsessive) as 500 to 600 mg at bedtime. The latter may be best if she has a sleep problem in particular. The suicide attempt on Effexor is not likely caused by the Effexor, but I can understand the feeling that a change is needed. Another alternative is to add Gabatril up to 16 mg bid to see if this helps in place of the Neurontin.