Unilateral Headache with Scalp and Hair Pain in an 8-year-old Boy

Camilla Antonsen; Marianthi Tsingos; Andrés Pascual

doi:10.1542/pir.2019-0188

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Camilla Antonsen*
Marianthi Tsingos, MD*,^†
Andrés Pascual, MD*

^*Pediatric Department, Groupement Hospitalier de l’Ouest Lémanique, Nyon, Switzerland;
^†General Pediatric Department, Geneva University Hospital, Geneva, Switzerland

Address correspondence to Camilla Antonsen, General Pediatric Department, Geneva University Hospital, Rue Willy-Donzé 6, 1205 Geneva, Switzerland. E-mail: camilla.antonsen{at}hcuge.ch

AUTHOR DISCLOSURE
Ms Antonsen and Drs Tsingos and Pascual have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

An 8-year-old boy presented to the pediatric emergency unit after a 1-week history of daily debilitating left parieto-temporo-occipital headache associated with scalp hair allodynia. On admission, he denies visual symptoms, nausea, vomiting, phono-/photophobia or any other focal deficit. He describes pain as constantly shooting but fluctuating in intensity during the day, occasionally causing him to wake up at night. Although symptoms started 1 day after a soccer game, they are neither triggered by anything specific, nor are they relieved by acetaminophen or ibuprofen. Lately, the boy did not attend school because of pain. His parents also report that their son has had unusual tiredness and reduced appetite.

Further questioning reveals only a minor head trauma without loss of consciousness 2 months ago, when he fell from a height of ∼2 m, landing on his hands with a slight impact on the back of his head. The boy has no remarkable past medical history and has had normal growth and development. Family history is remarkable for migraines particularly on the maternal side. There is no family history of other neurological diseases, brain tumors, or arteriovenous malformations.

His pediatrician saw him twice during the previous week. On both occasions his neurological examination was normal apart from an important pain when touching the scalp and even the hair on the left side of …