“We found out why your child’s headaches have not improved. There is a mass in your child’s brain that is causing the headaches and vomiting. The good news is that it is small and it is not pressing on any other parts of the brain, which would have impaired his neurological functions. We called Neurosurgery who will come and talk to you about what we need to do next.”
The mother is covering her face, hiding the tears that are streaming down her face.
“How are you feeling?”
“I don’t know. I’m scared…”
“I know this is a lot to take in and it is a scary thing to hear about your child. But because you trusted your mother’s instincts and brought him to the hospital again, we were able to find the problem early. What you did was brave and the best thing you could’ve done for your child. Please let us know if we can help you in anyway.”
A few hours ago, a 10 year-old boy came into the Emergency Department complaining of persistent headaches. Four days ago, the mother had taken him to his pediatrician who told them that he had migraines. They went home with ibuprofen (Motrin) and Ondansetron (Zofran) for his headaches and nausea. However, the headaches would not go away. The boy’s mother took him to an Emergency Department, where he received IV metoclopramide (Reglan) and diphenhydramine (Benadryl) to treat his migraine headaches. They left the ED with a neurology referral, who was booked until October. The boy still had a headache with multiple episodes of vomiting throughout the night. His mother was concerned and had brought him to another Emergency Department.
He had been having a constant frontal headache associated with nausea, vomiting and photophobia. His mother also had a history of migraine. His neurological exam was completely benign. All of these pointed towards migraine headaches. However, the usual treatment was not effective. And there was one part of the history that did not quite line up with migraines. His vomiting episodes were in the morning or when he got up from bed. One MRI later, our suspicions were confirmed: there was a small pineal mass.