A nine year old child with chronic paroxysmal hemicrania (CPH) was treated successfully using small dose aspirin prophylaxis at the California Medical Clinic for Headache, Encino, and the Harbor-UCLA Medical Center, Torrance, CA. Attacks occurred every 1½ hours throughout the day and awakened him from a sleep at night. They lasted a minimum of ten minutes and a maximum of 20 minutes and were localized to the left retroorbital and supraorbital areas. Pain was excruciating and nonthrobbing and was associated with ipsilateral lacrimation, nasal stuffiness, ptosis, and conjunctival injection. No relief was obtained with acetaminophen or phenobarbital. Baby aspirin (243 mg b.i.d. prevented the headaches and the dosage was decreased to 162 mg b.i.d. without further attacks. The aspirin was discontinued after three months without recurrence of headaches. The authors consider that this case is the first report of chronic paroxysmal hemicrania observed in a child, the earliest onset of CPH, and the first case obtaining relief from low dose prophylactic aspirin therapy. The effective daily dose of aspirin used (14.7 mg/kg) was less than the lowest mean level at risk for Reye’s syndrome (25.1 mg/kg). [1]

COMMENT. Indomethacin prophylaxis is considered the treatment of choice in adults with chronic paroxysmal hemicrania whereas salicylates are usually ineffective. Aspirin prophylaxis for chronic headache in children would not be a popular therapy generally because of the concern about Reye’s syndrome.