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 favors 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 (2-48 hours) but generally last around 16 hours. Neurologic exam 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
Many children presenting with a symptom cluster, including headache, may not fulfill the International Classification of Headaches diagnostic criteria. However, this should not preclude consideration of the diagnosis of migraine.
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