Neuropediatrics 2006; 37 - TP38
DOI: 10.1055/s-2006-945631

CARDIAC HEADACHE IN A HEALTHY 13 YEAR OLD BOY OR MIGRAINE-PRECIPITATED SYNCOPE IN LONG QT SYNDROME?

M Wilejto 1, KM Barlow 1
  • 1University of Calgary, Calgary, AB, Canada

Objectives: To highlight the importance of investigating syncope in the setting of headache Methods: A case report of a previously well 13 year old boy who presented with syncope, prolongation of the QT interval in association with a severe headache. The literature regarding cardiogenic headache and autonomic nervous system dysfunction in migraine is reviewed. Results: A previously well 13 year old boy presented with a gradual onset of a severe headache over 5 hours which was precipitated by playing the saxophone. He had syncopal episode lasting seconds while he was sitting at his desk, which was witnessed by the teacher. He reports a brief period of blurred vision beforehand. He was extremely pale and sweaty. There was no photophobia, phonophobia, nausea or vomiting. His cardiac and neurological examination was normal other than a marked bradycardia. His QT interval was prolonged. CT scan and LP were normal. His headache persisted for the next 48 hours, as did his bradycardia and long QT interval. His headache resolved in association with an increase in heart rate into the normal range. He was adopted and no family history was known. Tilt table up testing was positive with marked hypotension, a junctional rhythm and pre-syncopal symptoms. Long QT syndrome was diagnosed. He was commenced on beta-blockers and had a cardiac pacemaker inserted. Conclusion: There are several associations between acute headache and syncope. Headache has been reported as the sole presenting feature of cardiac ischemia in adults. Migraines are acutely associated with autonomic dysfunction with up to 40% having a prolonged corrected QT interval during the acute attack. Migraineurs also differ in their autonomic responses to pain and stress. There has been one previous case of migraine-associated vomiting and asystole in a 3 year old child but this is the first case of migraine being the presenting feature of long QT syndrome to our knowledge. The literature is discussed.