Case history
Case history
A 9-year-old boy presents with a 6-month history of recurrent headaches. He does not experience aura. Each headache builds up gradually over 20 minutes and is usually unilateral in nature, pulsating in quality, of moderate intensity, and aggravated by exercise. Nausea, vomiting, photophobia, and phonophobia are common accompanying symptoms. During attacks he favours going to sleep in a dark room, and will often go to bed earlier than usual and wake fully recovered the next day. Attacks can be of variable duration (2 to 48 hours) but generally last around 16 hours. Neurological examination during an attack is entirely normal. He is normotensive. He is completely well in between attacks and is making good academic progress. There is a strong family history of migraine with aura.
Other presentations
Aura may precede any migraine and further supports the diagnosis. Many children with a symptom cluster that includes headache may not perfectly match the International Headache Society migraine classification, although they may benefit from medical interventions currently in use.
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