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Published on: June 2, 2014
Recurrent headache in a five year old boy
Lokesh Saini1, Ranjith M Kumar1, Biswaroop Chakrabarty1
1Department of Pediatrics, Child Neurology Division, All India Institute of Medical Sciences, New Delhi, India.
Insights
Headache and neurological deficits associated with cerebrospinal fluid (CSF) lymphocytosis (HaNDL) is a rare migraine variant. Early diagnosis and migraine prophylaxis can lead to remission in pediatric cases.
Area of Science:
- Neurology
- Pediatrics
- Neuroimmunology
Background:
- Headache is uncommon in young children.
- Headache and neurological deficits associated with cerebrospinal fluid (CSF) lymphocytosis (HaNDL) is a rare migraine variant.
- Early childhood headaches warrant thorough investigation.
Observation:
- A 5-year-old boy experienced recurrent, week-long headaches for 6 months.
- Episodes were linked to paresthesias and CSF lymphocytosis with normal protein/sugar.
- Family history of migraine was noted.
Findings:
- Cerebrospinal fluid (CSF) analysis revealed lymphocytosis.
- Brain MRI, MR angiography, and venography were unremarkable.
- Infection and vasculitis work-ups were negative.
- Symptoms resolved with oral antimigraine prophylaxis, achieving 8 months remission.
Implications:
- HaNDL should be considered in pediatric patients presenting with recurrent headaches and neurological symptoms.
- Timely diagnosis of HaNDL can avert extensive investigations, treatments, and hospitalizations.
- Recognizing HaNDL facilitates appropriate management, potentially leading to prolonged remission.
Abstract:
Headache is infrequent in early childhood. Headache and neurological deficits associated with cerebrospinal fluid (CSF) lymphocytosis (HaNDL), a variant of migraine, is a rare disorder. A 5-year-old boy presented with recurrent episodes of headache for 6 months. Each episode lasted for a week and in the current episode, he was symptomatic for 3 days. All the episodes were associated with paresthesias and CSF lymplocytosis with normal protein and sugar. There was history of migraine in his family. His magnetic resonance imaging (MRI) brain with contrast with magnetic resonance (MR) angiography and venography were normal. Work-up for relevant causes of infection and vasculitis were negative. His symptoms subsided on oral antimigraine prophylaxis and he has been on remission for last 8 months. HaNDL should be considered in relevant clinical scenarios, as it prevents unnecessary investigations, therapy, and hospitalization.
