• Irene Toldo, Debora De Carlo, Rodica Mardari, Luca De Palma, Michela Gatta, Barbara Bolzonella, Margherita Nosadini, Luca Bartolini, Stefano Sartori, and Pier Antonio Battistella.
• Juvenile Headache Centre, Department of Woman and Child Health, University of Padua, Via Giustiniani, 3, 35128, Padova, Italy. irene.toldo@unipd.it
• J Headache Pain. 2013 Jan 25; 14 (1): 33.

BackgroundShort lasting headaches related to activity or cough are rare, particularly in childhood, and can be difficult to diagnose, especially in young children who are not able to describe their symptoms. In the literature there are few data on this topic in adults and the paediatric cases reported are even more rare.FindingsWe present the clinical history of a 7-year-old child and a 3-year-old child both diagnosed as having activity-related headaches, characterized by sudden onset of short lasting (few seconds) attacks, that were triggered by cough or exercise. There were no accompanying symptoms and the neurological examination was normal in both cases. Brain magnetic resonance imaging showed, in the first case, a cerebellar pilocytic astrocytoma and, in the second case, a Chiari 1 malformation. Both cases received an early diagnosis, were surgically treated and had a good prognosis at follow-up.ConclusionsWhen headache has a recent onset, it presents suddenly, and it is triggered by strain, even with normal neurological examination, neuroimaging is mandatory in order to exclude secondary headaches, especially in children.

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