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Three-year follow-up of a girl with chronic paroxysmal hemicrania
Inga Talvik1, Aleksandr Peet, Tiina Talvik
1Children's Clinic, Tartu University Hospital, Tartu, Estonia. inga.talkvik@kliinikum.ee
Insights
Chronic paroxysmal hemicrania in a child resolved with indomethacin. After treatment cessation, the patient remained pain-free, suggesting potential long-term remission of this headache disorder.
Area of Science:
- Neurology
- Pediatric Neurology
Background:
- Chronic paroxysmal hemicrania (CPH) is a rare headache disorder characterized by severe unilateral attacks.
- Diagnosis can be challenging, often requiring a therapeutic trial of indomethacin.
Observation:
- A 5-year-old girl presented with classic CPH symptoms from age 2 years 3 months.
- She experienced frequent, severe unilateral headaches for over a year before diagnosis.
- Initial treatment with indomethacin showed complete symptom response.
Findings:
- Indomethacin therapy was administered for 2 years and 6 months.
- Missed doses during the first year led to recurrent headaches, resolving upon readministration.
- After 2.5 years, a 1-week treatment gap resulted in no headache recurrence, prompting discontinuation.
- One year post-discontinuation, the patient remained symptom-free without medication.
Implications:
- This case highlights indomethacin's efficacy in pediatric CPH.
- Sustained remission after prolonged treatment suggests a potential for long-term cure or remission in some cases.
- Further research into treatment duration and potential for discontinuation in pediatric CPH is warranted.
Abstract:
This is a follow-up report of a girl, 5 years 4 months old, with classic symptoms of chronic paroxysmal hemicrania from the age of 2 years 3 months who had a complete response to indomethacin therapy. The patient suffered from frequent episodes of severe unilateral headaches for 1 year and 10 months before the diagnosis of chronic paroxysmal hemicrania was established. Indomethacin treatment lasted for 2 years and 6 months. During the first year of treatment, several doses of indomethacin were missed, which was followed by immediate return of hemicrania episodes and then quick resolution of symptoms after administration of indomethacin. After 2 years and 6 months of treatment, the parents missed the treatment for 1 week and the episodes did not recur. The treatment was discontinued. The patient was free from pain and off the medication 1 year later.
