Case Report: Shortest Course of Pediatric Paroxysmal Hemicrania

Abstract

Paroxysmal hemicrania (PH) is a rare primary headache disorder, especially among children. We describe herein a case with the shortest course of pediatric PH among previously reported cases, and the first case report of Japanese pediatric PH. An 11-year-old boy was referred to our clinic by his primary care physician for a headache evaluation. He had been complaining of severe, sharp, pulsating headache for 5 days. Attacks were restricted to the left side with a duration ranging from 2 to 20 minutes, 20-30 times a day. Attacks were associated with left autonomic symptoms (conjunctival injection, lacrimation, nasal congestion, eyelid edema, and ptosis). Two days after we prescribed indomethacin at 0.9 mg/kg/day, the patient was headache free. He stopped taking indomethacin 14 days after consultation because of drug eruptions. As of the time of writing, more than 1 year later, he has experienced no recurrence of headache. This case indicates the importance of improving awareness among general doctors regarding PH in children, and of conducting further investigations about low-dose, short-term indomethacin treatment.

Keywords: Japanese; child; paroxysmal hemicrania; pediatric; short course.

Figure 1

Clinical findings. (A) Left unilateral autonomic symptoms on the day of consultation. He showed conjunctival injection, lacrimation, nasal congestion, eyelid edema, and ptosis. The picture was taken just after a headache attack in the consultation room. (B) Autonomic symptoms disappeared by 14 days after consultation.