We present the case of a three-year-old preschooler who presented to his health centre with a bitemporal, daily, evening headache lasting for hours, which subsided after analgesia. The pain does not occur during sleep and does not interfere with her daily activities. There is no aura, sonophobia or photophobia. No vomiting or other symptoms. Personal history of no interest. Normal psychomotor and postnatal development. Physical and neurological examination was normal. Referred to Ophthalmology, where pathology was ruled out. A blood test was requested, with a ferritin level of 8 ng/ml, and the haemogram and other biochemistry were anodine. Following this, treatment with oral iron was started.
Two months later, she consulted Neuropaediatrics for persistent headache and was referred to Neuropaediatrics (normal brain magnetic resonance imaging [MRI]) and an analytical control was performed to assess the previous iron deficiency, determining IgA anti-transglutaminase antibodies (> 128 U/ml) and IgA (normal). Subsequently, a biopsy was obtained confirming coeliac disease with Marsh type II-III villous atrophy, and low-resolution histocompatibility system typing (human leukocyte antigen [HLA]) was performed, obtaining a DQ2 haplotype of coeliac susceptibility in cis. Following diagnosis, the patient was started on a gluten-free diet and progressed favourably, with disappearance of the headache and correction of ferritin levels.
