Transient Headache With Numbness of Half of the Tongue

This is a 15-year-old boy with a history of mi-graines since about aged 4. The migraines occurabout once every 6 months and are described as a se-vere bifrontal throbbing associated with nausea, lightand noise sensitivity, and sometimes vomiting but noaura. The headaches last about a half day, and he of-ten goes to bed during the attack. Acetaminophen isof mild help.For the last 6 months, he has developed a newtype of headache, occurring approximately once ev-ery 2 weeks. These headaches are triggered by activ-ity such as throwing a football hard, hitting an over-head ball in tennis, or chasing his dog around in acircle, but not by weightlifting or straining with abowel movement. He describes a sharp pain in themid nuchal-occipital region associated with numb-ness of the left side of the tongue, all lasting about 20seconds.Past medical history is negative except for con-genital bilateral hearing loss. Family history is re-markable for migraines in his father and congenitalhearing loss. Neurological examination is normal, ex-cept for profound hearing loss bilaterally. An MRIscan of the brain shows a large retrocerebellar arach-noid cyst without hydrocephalus. The cerebellar ton-sils are above the foramen magnum.