A child with infrequent episodic tension-type headache

Abstract

Andrew suffered from infrequent episodic headache from the age of 6. In his past medical history, Andrew showed a mild language delay and had difficulties in copying from the blackboard in primary school suggesting an underlying visual problem. An ophthalmological assessment at the age of 8 years showed him to have “Marcus Gunn syndrome” and myopia. Despite the use of corrective lenses, Andrew continued to experience school difficulties and episodic headache. On moving to secondary school, Andrew’s performance in reading and writing declined, he expressed emotional and relationship problems, and his headache worsened. Psychological assessment revealed recurrent depressive thoughts and anxiety symptoms associated with social phobia necessitating psychotherapy for 18 month with no improvement. Neurological evaluation at the age of 14 years showed a progressive increase of headache frequency (two to three times a week). A complete neuropsychological assessment showed a specific learning disorder (dysgraphia) associated with a severe expressive language disorder. On the implementation of specific school measures, he had an improvement in anxiety and a reduction in headache frequency.