Indomethacin-responsive refractory headache: Two case reports in children after hemispherectomy for Rasmussen's...

Area of Science:

• Pediatric Neurology
• Headache Medicine
• Neuroinflammation

Background:

• Indomethacin-responsive headaches, including trigeminal autonomic cephalalgias (TACs), are observed in youth.
• TACs are rare in pediatrics and may present differently than in adults.
• Secondary causes of side-locked headaches necessitate imaging; post-craniotomy headaches responsive to indomethacin are documented in adults but not children.

Purpose of the Study:

• To describe the occurrence and treatment of post-craniotomy headaches in children with a history of Rasmussen's encephalitis.
• To evaluate the efficacy of indomethacin in managing refractory side-locked headaches in this pediatric population.

Main Methods:

• Case report of two children with Rasmussen's encephalitis who underwent functional hemispherectomies.
• Observation of headache development and subsequent treatment with indomethacin.

Main Results:

• Both children developed debilitating, side-locked headaches ipsilateral to their encephalitis and surgery, months post-operation.
• Headaches were rapidly and completely responsive to low-dose indomethacin (0.14-0.5 mg/kg/day), with sustained headache freedom.

Conclusions:

• Refractory side-locked headaches in children following craniotomy or neuroinflammatory conditions warrant consideration of indomethacin.
• Indomethacin may be a valuable treatment option after excluding other secondary causes.