title: Short lasting activity-related headaches with sudden onset in children: a case-based reasoning on classification and diagnosis.
abstract: BACKGROUND
  Short lasting headaches related to activity or cough are rare, particularly in childhood, and can be difficult to diagnose, especially in young children who are not able to describe their symptoms. In the literature there are few data on this topic in adults and the paediatric cases reported are even more rare.
  
  
  RESULTS
  We present the clinical history of a 7-year-old child and a 3-year-old child both diagnosed as having activity-related headaches, characterized by sudden onset of short lasting (few seconds) attacks, that were triggered by cough or exercise. There were no accompanying symptoms and the neurological examination was normal in both cases. Brain magnetic resonance imaging showed, in the first case, a cerebellar pilocytic astrocytoma and, in the second case, a Chiari 1 malformation. Both cases received an early diagnosis, were surgically treated and had a good prognosis at follow-up.
  
  
  CONCLUSIONS
  When headache has a recent onset, it presents suddenly, and it is triggered by strain, even with normal neurological examination, neuroimaging is mandatory in order to exclude secondary headaches, especially in children.
authors.affiliation: Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Via Giustiniani, 3, 35128, Padova, Italy. irene.toldo@unipd.it
authors.forename: Irene
authors.initials: I
authors.lastname: Toldo
authors.forename: Debora
authors.initials: D
authors.lastname: De Carlo
authors.forename: Rodica
authors.initials: R
authors.lastname: Mardari
authors.forename: Luca
authors.initials: L
authors.lastname: De Palma
authors.forename: Michela
authors.initials: M
authors.lastname: Gatta
authors.forename: Barbara
authors.initials: B
authors.lastname: Bolzonella
authors.forename: Margherita
authors.initials: M
authors.lastname: Nosadini
authors.forename: Luca
authors.initials: L
authors.lastname: Bartolini
authors.forename: Stefano
authors.initials: S
authors.lastname: Sartori
authors.forename: Pier Antonio
authors.initials: PA
authors.lastname: Battistella
mesh_terms: D001139:Arnold-Chiari Malformation / Q000150:complications / Q000175:diagnosis*; D001254:Astrocytoma / Q000150:complications / Q000175:diagnosis*; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000150:complications; D015444:Exercise; D006261:Headache / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging
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