I evaluated this boy at 12 years of age. He had headaches since the age of 7 to 8 years old, which later began worsening. The severe headaches lasted for several hours and required him to lie down and sleep twice per month. He missed 4 days of school because of the headaches. His mother was able to tell when a headache was coming because there was a different look in his eyes. She thought the whites of his eyes became darker and his eyes appeared sunken. He seemed confused and dazed with the headache. The headaches were exacerbated by activity, heat, and loud noises. Sleep provided relief. The headaches were associated with abdominal pain and anorexia. There was no photophobia, nausea, vomiting, or aura. He had no history for seizures, head trauma, or loss of consciousness. Family history was positive for severe headaches in his father when he was about the same age. Physical and neurologic examinations were normal with blood pressure 110/60 and pulse 90. He was treated with propranolol long-acting 60 mg daily. His mother telephoned a few weeks later. She was worried because she said his blood pressure and pulse were low, and reported blood pressure 100/41 and pulse 52. She stopped propranolol for several days, and he had a severe headache. I reassured her that the changes in pulse and blood pressure in a child/teenager with a healthy heart were of no concern. Propranolol was restarted. When he returned 4 weeks after the initial visit, he submitted an illustration of his headaches. He was free of headaches, and asymptomatic with pulse 58.