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The Journal of Headache and Pain

Official Journal of the "European Headache Federation" and of "Lifting The Burden - The Global Campaign against Headache"

The Journal of Headache and Pain Cover Image

Volume 16 Supplement 1

1st Joint ANIRCEF-SISC Congress

Open Access

P047. Paroxysmal episodic hemicrania in a child. A complex differential diagnosis

  • Roberto Frusciante1Email author,
  • Alessandro Capuano1,
  • Catello Vollono2,
  • Federico Vigevano1,
  • Samuela Tarantino1 and
  • Massimiliano Valeriani1, 3
The Journal of Headache and Pain201516(Suppl 1):A100

Published: 28 September 2015




Headache is a common disease in children. Differential diagnosis of primary headaches in children is challenging due to some peculiar features of headache at that age. We describe a case in a child who presented with headache resembling characteristics of migraine without aura, paroxysmal hemicrania and cluster headache.

Methods and results

An 11-year-old boy referred to our Headache Centre suffering from headache for the past 5 years. Headache characteristics were: frontal pain, constricting in quality and excruciating pain intensity, at times vomiting. Duration of attacks was referred ranging from 20 to 40 minutes, headache occurred daily during the last 2 months. Attacks recurred many times daily. Attacks of headache occurred in periods lasting from 1 to 2 months, separated by pain-free periods lasting 1 month. During the headache attacks, the child presented eyelid oedema and nasal congestion. Personal medical history was negative. Familial history was positive for migraine without aura (paternal aunt). General and neurological examination, including fundus oculi, were normal. MRI scan resulted normal. Previous prophylaxis with pizotifen, amitriptyline, verapamil, topiramate and prednisone were ineffective, instead indomethacin was effective.


In children, the characteristics of headache often overlap between different forms. Cluster headache is a rare form and very few cases in pediatric age have been described[1]. Our patient presented headache attacks with autonomic activation (eyelid oedema and nasal congestion), that usually rule out the diagnosis of migraine attacks. On the contrary, these features are thought to be specific of TACs. Furthermore, the clustering of attacks, more than one per day, the ineffectiveness of different prophylactic therapies, and the complete efficacy of therapeutic doses of indomethacin, support the diagnosis of paroxysmal episodic hemicrania in our patient.

Written informed consent to publication was obtained from the patient(s).

Authors’ Affiliations

Headache Centre, Bambino Gesù Children's Hospital, Rome, Italy
Department of Geriatrics, Neurosciences & Orthopedics, Unit of Neurophysiopathology and Sleep Medicine, Catholic University, Policlinico Agostino Gemelli, Rome, Italy
Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark


  1. Tarantino S, Vollono C, Capuano A, Vigevano F, Valeriani M: Chronic paroxysmal hemicrania in paediatric age: report of two cases. J Headache Pain. 2011, 12 (2): 263-7. 10.1007/s10194-011-0315-7.PubMed CentralView ArticlePubMedGoogle Scholar


© Frusciante et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.


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