Response to Harry Potter and the Curse of Headache

Sheftell et al have considered the differential diagnosis of Harry Potter's headache in detail.¹ We would, however, like to draw their attention to one additional diagnosis which we think they have overlooked.

The striking thing about Harry Potter on physical examination is of course the “zig-zag” scar on the right side of his forehead. A unifying diagnosis that relates a scar on the forehead to migraine and other facial neuralgic pain would be linear scleroderma “en coup de sabre” (Fig.). Scleroderma “en coup de sabre” is a rare localized form of scleroderma or morphoea usually located on the forehead to one side of the midline. It is so named because of its resemblance to a scar made by the cut of a sabre, although a wand could leave a similar mark. A zig-zag pattern has not previously been described.

Figure Figure.—. An example of Scleroderma “en coup de sabre” on the right forehead. (Reproduced with permission from http://www.dermnetnz.org)

Scleroderma en coup de sabre and the related condition, Parry Romberg syndrome (progressive facial hemiatrophy), are known to be associated with a high frequency of migraine (52% in one study²) and facial pain. The etiology of these conditions is probably autoimmune. In boy wizards, however, it remains a possibility that the cause could be an injury from a wand in the infantile period.