Pre-exercise indomethacin farnesil for primary exercise headache in an adolescent: A case report

Primary exercise headache (PEH) occurs only during or shortly after strenuous physical exercise. Pediatric cases are under-recognized, and there is little practical guidance on its prevention. A previously healthy, 14-year-old, female patient experienced exertion-only, holocranial, constricting headaches only while performing the 100-m, all-out sprints. The headache abated within 15 min with rest. A neurological examination and brain magnetic resonance imaging/magnetic resonance angiography were normal. Over-the-counter analgesics were ineffective, and ergotamine 1 mg provided modest benefit. Pre-exercise indomethacin farnesil 25 mg administered 30–60 min before running led to a clear improvement. Increasing the dosage to 50 mg after two months achieved complete control over the symptom. By the 12-month follow-up, the patient had become capable of participating in athletic activities without any adverse events. After excluding etiologies of secondary headaches, pre-exercise indomethacin farnesil therapy controlled the PEH well without any adverse effects, enabling the patient to resume her athletic activities. The present case provides practical details on the dosing, timing, and tolerability of indomethacin farnesil for PEH.