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Successful agomelatine monotherapy for an adolescent with attention deficit hyperactivity disorder and comorbid migraine

A 15-year-old female Kuwaiti youngster was presented to our OPD clinic in accompaniment of her parents for evaluation of scholastic unattainment and behavioral disruption. She is the eldest of four siblings of nonconsanguineous monogamous family. She is the product of noncompli-cated elective Caesarean section with normal developmental milestones. As a toddler, her parents report that she has always been fussy and colicky, adventurous, and curious exploring the surroundings, impersistent at toy playing and throwing excessive tantrums. During elementary school, she has always been described as overactive with frequent risk-taking behaviors, like crossing the street carelessly, paying no attention to vehicles. As getting older, she, more often than not, was noticed to be pensive and day-dreaming. Her mother always criticized her for being messy, forgetful, and a loser. She was markedly below par regarding academic tasks at school. She keeps only little company that can withstand her moodiness. Teachers always denigrate her being a bully, noisy in the classroom, and arguing too much. Remedial teaching and extra tutors could not help. There is no family of neuropsychiatric disorders. She had her menarche at age of 12 with now regular menses. No history of illicit drug use. No history of head trauma, epilepsy, or toxic exposures. No history of tics. Eye, ear, nose, and throat (EENT) evaluation was non-contributory. She has episodic migrainious headaches and is currently being maintained on prophylactic topiramate but with poor response. She was seen by a private general psychiatrist, where a diagnosis of attention deficit hyperactivity disorder (ADHD)-combined presentation was enter-tained and was accordingly prescribed atomoxetine 1.2mg/kg/d for 3months with mediocre response at best, as reported by patient and parents and concordant