Cerebral sinovenous thrombosis masquerading as migraine: a case report.

Headaches are common during childhood and a common pediatric presentation to emergency departments (EDs). The most common diagnoses for acute headache in the pediatric ED are viral upper respiratory tract infection with fever, sinusitis, and migraine, accounting for 70% to 75% of presentations; serious neurologic diagnoses are rare. Most literature recommends against neuroimaging for uncomplicated headache given the absence of any other signs or symptoms associated with causes of intracranial pathology and the presence of a normal physical examination. Cerebral sinovenous thrombosis (CSVT) is a rare entity whose diagnosis relies heavily on neuroimaging and which carries high morbidity and mortality if untreated. Pediatric CSVT has yet to be presented in the emergency medicine literature. We report the case of a child who presented to the pediatric ED with headache, which was complicated by background difficulties with aggression and other behavioral issues. This case illustrates an extremely rare ED presentation of CSVT masquerading as migraine headache and discusses the diagnostic dilemma of neuroimaging.