13-year-old patient with headache, unclear on/off symptoms and psychosocial burden

Case Report: 13-year-old formerly healthy male patient presents with headache since 2 to 3 weeks. Headache is described as unilateral right sided, occipital, stabbing, and persistent with changing intensity. The patient shows redness of the right eye and uncertain meningism. Trigeminal pain on the right side is detectable at first but is not reproducible. The remaining neurologic examination is normal. X-ray of the paranasal sinus is nonpathologic.

The following day the pain persists but there are no further symptoms. Several psychosocial burdens can be revealed. The patient is dismissed again. The same night he is admitted to the hospital with severe headache. There are 480/3 cells in the CSF and the MRI shows signs of a neuritis nervi trigemini on the right side. Borrelia-specific antibodies are detected in blood serum and CSF. After therapy with doxycycline, the patient recovers quickly.