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Chronic paroxysmal hemicrania in a young child: possible relation to ipsilateral occipital infarction
D Broeske1, N J Lenn, E Cantos
1Department of Neurology, School of Medicine, State University of New York, Stony Brook 11794-8121.
Insights
A child experienced daily chronic paroxysmal hemicrania starting at age 3. Indomethacin provided complete relief, suggesting a symptomatic cause possibly linked to an occipital infarction.
Area of Science:
- Neurology
- Pediatric Neurology
- Headache Medicine
Background:
- Chronic paroxysmal hemicrania (CPH) is a rare headache disorder.
- It typically presents in adulthood, with a later age of onset.
- Symptomatic causes are less common than primary CPH.
Observation:
- A 3-year-old child presented with daily chronic paroxysmal hemicrania episodes lasting over 2 years.
- The patient experienced an unusually early onset of this debilitating headache condition.
- An ipsilateral occipital hemorrhagic infarction was noted, potentially predating the headache onset.
Findings:
- Indomethacin, a first-line treatment for CPH, resulted in complete symptom relief.
- The early onset and persistent nature of the headaches suggest a possible symptomatic etiology.
- The co-occurring occipital infarction may play a role in the headache pathogenesis.
Implications:
- This case highlights the possibility of symptomatic chronic paroxysmal hemicrania in young children.
- Early diagnosis and prompt treatment with indomethacin are crucial for managing CPH.
- Further investigation into the link between vascular lesions and early-onset CPH is warranted.
Abstract:
We report a child with chronic paroxysmal hemicrania beginning at 3 years of age with more than 2 years of daily episodes. Indomethacin produced total relief. An ipsilateral, occipital hemorrhagic infarction, probably predating the headaches, may have contributed to their pathogenesis. This is an unusually early onset and persistent chronic paroxysmal hemicrania of possible symptomatic type.