A 14-year-old woman underwent surgery for low grade astrocytoma in the right frontal region at 3 years of age (without sequelae) and diagnosed with migraine without aura at 6 years of age, so she remains in follow-up.
She suffered worsening of her headache crisis in the last month, now appearing daily and predominantly at night, with longer duration and intensity and poor response to treatment with nonsteroidal anti-inflammatory drugs.
Coinciding with the episodes, he describes a feeling of dying and an intense fear of dying, similar to the symptoms he had when the astrocytoma was diagnosed.
The family history included mother diagnosed with anxiety syndrome, dysthymia and headache due to analgesic abuse.
Neurological examination was normal.
Magnetic resonance imaging (MRI) of the head was requested, which showed postsurgical changes in the right frontal region with no evidence of local tumor recurrence and a 15 mm pineal cyst (also known) that increased in size (11 mm compared to controls).
Analytical tests were performed with Gn, FSH, LH, GH, ACTH and growth hormone (HCG) and an electroencephalogram showed no abnormalities.
Symptomatic treatment of headache and a new radiological control in three months was decided, showing resolution of bleeding with disappearance of symptoms.
