Hello,

Thanks for the query.

The information you have provided seems inadequate.

However, with the available information, common possibilities are:

1. When he has severe pain in the head that is intolerable to him.

2. Few children throws tamper tantrum (fairly common between 3 to 5 years and is normal), a temperamental difficulty. But, it is to be consulted when tantrum is severe or lasting for a long period.

3. Associated stress to child, within family, separated parents, or any other psychological issues with which child is struggling with.

4. Any other associated medical condition.

But, as you said that he pulls his hair when he is upset, this may be because of stress as mentioned above or may be Trichotillomania.

Continue with the medications for sinus problem as suggested by your doctor. Apart from continuing these medications, you may discuss the above-mentioned possibilities with him and ask him whether a child psychologist need to be consulted .

Hope I have answered your query.

I am available to answer your follow up questions further.

Regards,

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Hello dear

I sincerely apologize for the delay in replying to you.

It seems the sequence of events (hurting, getting upset, pain and pulling hairs) is important in this case.

If plethora of events starts with "getting upset for some reason", than, may be psychological component could be a possibility.

But, if the pain starts after hurting or crying, without any apparent reason, than, may be some vascular causes or neurological causes for severe headache could be looked into. Is the child responding to treatment prescribed for sinus problem by the local doctor ?

And I could not get any reply from you regarding for presence of any psychosocial issues. It is unlikely to be related to trichotillomania.

The diagnosis in children needs careful observation and careful history taking by a competent specialist followed by any investigations, if necessary. Moreover the dictum is first to rule out any organic cause even if you are suspecting psychological reason.

Have you done any investigations or have your local doctor have suggested any investigations ?

Hope this answer is useful to you.

Wish your grandson a speedy relief of pain.


Thanks

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Hi XXXXXXX
Thanks for one additional information that you say that it has occurred few times when he started to laugh which make me to think a possibility of seizure disorder (gelastic epilepsy [rare}or may be a part of behavioral component or XXXXXXX of complex partial seizure). Headache may be a part of XXXXXXX

And as because, sometimes emotional events like laughing, crying or any stressful thing can precipitate seizure and the age of the child is 4 years old, seizure disorder can be a posibility, which may be of vascular or non-vascular origin.

In that case, he should be consulted with a specialist (pediatric neurologist or neurologist or peditrician in that order of preference) and the doctor might ask you to do EEG, MRI Brain, if he thinks seizure disorder a possibility. MRI Brain can identify any vascular lesion.

Moreover, usually, seizure episodes last for few seconds to few minutes, client might feel sleepy after the episode is over, course is episodic nature. Professionally speaking, sometimes it is really difficult to say weather it is seizure or not, though in very small percentage of cases.

I am available to continue discussing further,

Wish your grandson a quick recovery

Thank you

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