At presentation, Peter was 14
years old and had presented with
migraines since the age of 8. He
was taking Pizotifen and his headaches were
well controlled. Over the past four weeks he
had started getting headaches again. They
were in a similar location to his migraines, but
were different in nature – he couldn’t put his
finger on exactly how.
His mother took him to see Dr G who
attributed his increased headaches to
puberty and the fact that he had a new job
doing a morning paper round. He advised
better sleep hygiene and suggested that
Peter use Sumatriptan when the headaches
Four weeks later the headaches were no
different. In addition, Peter had started
to feel sick a lot in the mornings and
occasionally vomited. His mother told Dr G
she was worried he had a brain tumour. In
the consultation Peter admitted to feeling
stressed about upcoming exams and was
tearful, stating that he couldn’t cope with
the headaches any more. Examination was
normal and Dr G felt that Peter was anxious.
He arranged a CAMHS referral and agreed to
see him again in two weeks.
After two weeks his mother attended with
him and they saw the GP registrar, Dr W.
Peter’s mother was concerned that Peter
was sleeping every evening for an hour
after school and seemed lethargic and
disinterested most of the time. She wondered
whether Peter might be depressed.
Dr W questioned Peter further and found
that the headaches were present on
wakening most mornings and that he had
been sick on occasions at school break time.
Neurological examination was normal.
Dr W was concerned about Peter’s
symptoms and arranged same day referral
to paediatrics. The next day, following an
MRI scan, Peter was diagnosed with a brain
tumour. Subsequently this turned out to be a
low grade astrocytoma and Peter underwent
surgery a few days later.
Fortunately after six months, Peter is doing
well, and the surgery is believed to be
curative at this stage.
Peter’s mother made a complaint to the
practice about the six-week delay in his
diagnosis. Dr G undertook a SEA with the
practice team to review the case. He met
with Peter and his mother, offered an apology
and shared with them what they had learnt
from the incident and what steps the GPs
would take to raise their awareness of
childhood brain tumours. Peter’s mother was
satisfied with this approach and no further
action was taken.
- Always reassess a child with a history of migraine or tension headaches if the headache changes.
- Suspect a brain tumour if there is a history of persistent headaches on wakening for more than four weeks.
- Persistent vomiting on wakening for more than two weeks should be considered a red flag.
- Lethargy is the most common behavioural change associated with brain tumors.
- Listen to the parents' concerns as they know their children well and can pick up subtle changes in their behaviour and health.