Adolescent with Unilateral Headache and Associated Neurological Symptoms

Case at a Glance

A 16-year-old female presenting with a 6-week history of severe left-sided headaches with progressive neurological symptoms including facial sensory changes, muscle weakness, and altered consciousness episodes.

Patient's Story

The patient reported severe, predominantly non-throbbing headaches localized to the left temple region, occurring daily for 6 weeks. Episodes typically lasted 1-4 hours and were severe enough to cause loss of consciousness. Pain worsened with movement and was accompanied by pressure sensations behind the left eye, cheek, and jaw. The left temple remained tender even between episodes. Additional symptoms included nausea, left eyelid twitching, and neck stiffness. In the preceding 2 weeks, she developed new concerning symptoms: warm, tingling sensations in the left scalp, ear, and face; left facial muscle weakness requiring increased effort for movement; and intermittent random pain or cold sensations throughout her body described as feeling like ice being held against the skin or areas being 'ripped open.' Paracetamol provided partial relief, reducing headache intensity to a dull pressure but not eliminating other symptoms.

Initial Assessment

Physical examination revealed a 16-year-old female, height 154cm, weight 47kg, appearing uncomfortable but alert. Vital signs were stable. Neurological examination showed left facial muscle weakness, though facial symmetry appeared grossly normal. Left temple tenderness on palpation was noted. The patient reported taking echinacea supplements daily but no other medications. Family history was not immediately available due to parental reluctance to seek medical care.

The Diagnostic Journey

Given the constellation of unilateral headache, facial weakness, sensory changes, and episodes of altered consciousness, immediate neurological evaluation was warranted. The progressive nature of symptoms over 6 weeks, particularly the development of facial weakness and sensory disturbances, raised concern for secondary headache causes including intracranial pathology.

Final Diagnosis

Pending comprehensive neurological evaluation including neuroimaging (CT/MRI brain) to rule out secondary causes of headache such as intracranial mass, vascular malformation, or inflammatory conditions. Differential diagnosis includes secondary headache disorder, possible migraine with aura, trigeminal neuralgia, or cluster headache variant.

Treatment Plan

Immediate referral to emergency department or urgent care for comprehensive neurological evaluation and neuroimaging. Pain management with appropriate analgesics while investigating underlying cause. Discontinuation of non-essential supplements pending evaluation. Neurology consultation for specialized headache management once secondary causes are excluded.

Outcome and Follow-up

Patient was advised to seek immediate medical attention despite family reluctance. Emergency or urgent care evaluation was recommended due to the progressive nature of symptoms, particularly the facial weakness and altered consciousness episodes. Long-term management would depend on imaging results and neurological consultation findings.