Headache with vomiting in infancy

C., 2.5 years old, came to our Emergency Department (ED) because of recurrent episodes of frontal headache and morning vomiting for 7 days. Family history was positive for migraine with aura and Meniere syndrome. On suspicion of a symptomatic headache, we perform blood tests which showed normal results and fundus oculi (FO) examination showed evidence of prominent optic disc. Brain CT scan and MRI were normal. Clinical condi-tions of C. improved rapidly with normali-zation of FO, so we decided not to treat. One year later, C. came back to our ED with a recurrence of symptoms; we per-formed blood tests again and FO exam showed optic disc swelling and hyperemia. Brain MRI showed expansion of the periop-tic sheath. During hospitalization, C. still presented recurrent headache and vomit-ing, especially in the morning, poorly re-sponsive to analgesics and antiemetics drugs. Because of her age, on suspicion of benign intracranial hypertension, we de-cided not to perform lumbar puncture and to start treatment with acetazolamide (250 mg to 375 mg/day). The little girl’s condi-tions improved gradually and symptoms disappeared in about 5 days. Benign in-tracranial hypertension is a syndrome characterized by headache, papilledema, high pressure and normal composition of cerebrospinal fluid, in the absence of neuroimaging abnormalities and other identifiable causes. The incidence is about 0.9 /100 000 and increases in obese ado-lescents. This case is remarkable because of age of onset and absence of overweight.