Chronic paroxysmal hemicrania in paediatric age: report of two cases
Samuela Tarantino1, Catello Vollono, Alessandro Capuano
1Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy. gone.st@libero.it
Insights
Chronic paroxysmal hemicrania (CPH), a rare headache disorder, was diagnosed in two boys. Their severe headaches responded well to indomethacin, suggesting CPH in pediatric patients.
Area of Science:
- Neurology
- Pediatric Neurology
- Headache Medicine
Background:
- Chronic paroxysmal hemicrania (CPH) is a rare primary headache disorder within the trigeminal autonomic cephalalgia (TAC) group.
- CPH is characterized by frequent, short-lasting, severe unilateral headaches with autonomic symptoms, and is definitively responsive to indomethacin.
Observation:
- Two pediatric cases, a 7-year-old and an 11-year-old boy, presented with recurrent, short-lasting, severe headaches.
- The headaches were unilateral, fronto-orbital-temporal, accompanied by cranial autonomic features, and refractory to conventional analgesics.
Findings:
- Clinical presentation and absolute response to indomethacin strongly suggested a diagnosis of CPH in both pediatric patients.
- These cases represent rare instances of CPH described in the pediatric age group.
Implications:
- This study expands the understanding of CPH presentation in children.
- Highlights the importance of considering CPH in pediatric patients with refractory headaches and autonomic features.
- Emphasizes indomethacin's diagnostic and therapeutic role in pediatric CPH.
Abstract:
Chronic paroxysmal hemicrania (CPH) is a rare primary headache syndrome, which is classified along with hemicrania continua and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) as trigeminal autonomic cephalalgia (TACs). CPH is characterised by short-lasting (2-30 min), severe and multiple (more than 5/day) pain attacks. Headache is unilateral, and fronto-orbital-temporal pain is combined with cranial autonomic symptoms. According to the International Classification of Headache Disorders, 2nd edition, the attacks are absolutely responsive to indomethacin. CPH has been only rarely and incompletely described in the developmental age. Here, we describe two cases concerning a 7-year-old boy and a 11-year-old boy with short-lasting, recurrent headache combined with cranial autonomic features. Pain was described as excruciating, and was non-responsive to most traditional analgesic drugs. The clinical features of our children's headache and the positive response to indomethacin led us to propose the diagnosis of CPH. Therefore, our children can be included amongst the very few cases of this trigeminal autonomic cephalgia described in the paediatric age.
Related Concept Videos
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:22Epilepsy ll: Types