Short lasting activity-related headaches with sudden onset in children: a case-based reasoning on classification and diagnosis

Findings: 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 Chiari 1 malformation and, in the second case, a cerebellar pilocytic astrocytoma. Both cases received an early diagnosis, were surgically treated and had a good prognosis at follow-up.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.