Preadolescent Indomethacin-Responsive Headaches Without Autonomic Symptoms


  • Conflict of Interest: None.

Address all correspondence to K.A. Myers, Pediatrics, Division of Neurology, University of Calgary, Alberta Children's Hospital, 2888 Shaganappi Drive NW, Calgary, AB, Canada T3B 6A8.



A small case series is presented of preadolescent patients with indomethacin-responsive headache.


Preadolescent indomethacin-responsive headache is a rare and poorly understood entity, with few published cases in the literature.


Two young children had similar presentations of indomethacin-responsive headaches. Both patients experienced frequent paroxysmal episodes of sudden-onset severe frontal or temporal head pain. The events lasted seconds to minutes in duration, and varied in frequency ranging from multiple episodes per week to multiple events per day. There were no associated autonomic or migrainous symptoms, and a comprehensive work-up revealed no secondary causes for the debilitating headaches. Both patients had dramatic clinical improvement with indomethacin.


There may be a pediatric syndrome of indomethacin-responsive headache without autonomic symptoms that does not fit well within current diagnostic classifications. More research is needed to determine appropriate dosage and duration of treatment in pediatric indomethacin-responsive headache. Once secondary causes have been ruled out, a trial of indomethacin should be considered in pediatric patients presenting with severe paroxysmal headaches, even if no autonomic symptoms are present.