A boy aged five years presented with a new recurrent headache over the past month, associated with nausea and occasional vomiting, as well as photophobia, phonophobia and pallor. The episodes lasted up to six hours at a time and occurred 3–4 times per week. They were usually preceded by approximately 30 minutes of irritable and dysregulated behaviour. They occurred at any time of the day. The patient had only woken up once with the headache. There was no abdominal pain.

The patient’s history included atopic dermatitis and obstructive sleep apnoea successfully treated with tonsillectomy. He lived with his mother and sister and attended day care. His immunisations were up to date and he was developmentally appropriate. His mother reported experiencing classic migraines with aura.