Case 4: Six-Year-Old With Acute Headache Onset at Disney World

Presenters: Eric Kossoff, MD, Chief Fellow, Pediatric Neurology, Johns Hopkins University School of Medicine, Baltimore, MarylandMentor: Preston Calvert, MD, Neurologist, Alexandria, Virginia

March 15, 2002

In This Article

Case Presentation & History/Current Symptoms

A 6-year-old boy presented to his pediatrician after 1 week of severe frontal headache accompanied by photophobia and phonophobia. About 1 week later, the boy was brought to the pediatric neurology department at Johns Hopkins Hospital.

History/Current Symptoms

Acute onset of headaches began during a vacation (October 2000) while the boy, who lives in Maryland, was watching a laser show at Disney World. He had no prior medical history before the onset of headaches and had not received any recent medications. He had been a full-term baby, with normal birth, delivery, and development. Immunizations were up to date.

Headaches initially resolved, but then recurred upon his return to Maryland and were more severe with nausea and vomiting. The child was brought to his pediatrician after 4 days of severe frontal headaches with photophobia and phonophobia and a computed tomography (CT) scan proved normal. Three days later (1 week before presenting to Johns Hopkins), the child began to have daily headaches with nausea and occasional vomiting.

Headache Characteristics at Current Presentation

The patient suffered from severe frontal headaches, which were worse in the morning and with positional changes. The headaches did not awaken him from sleep and were not accompanied by visual auras or prodrome; sensorimotor changes; or diplopia or visual field deficits.

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