A 16-year-old-boy was seen in the pediatric neurology clinic complaining of paroxysmal headaches and visual changes. The patient was suffering from severe headaches occurring up to three times per month, lasting 3 hours to 8 days (usually 1 to 2 days), which subsided on medication containing a combination of acetaminophen, aspirin, and caffeine. He was prescribed oral and nasal spray of sumatriptan by his pediatrician. However, he was brought to an emergency department because of severe headaches that did not respond to sumatriptan.
Magnetic resonance imaging (MRI) of the brain was normal. On evaluation in the clinic, the patient described the headaches as pounding and rated the pain as 5 to 7 on a scale of 1 to 10 (severe). Pain originating in the back of the head and extended to the forehead associated with dizziness, nausea, neck pain, and mosaic vision, and typically relieved by…
