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I read your question carefully and I understand your concern. I also read the report from your doctors from which it is evident that this is not a straightforward case, observation of the evolution in time and other tests will be needed.

Now you seem to be wondering about the significance of that MRI finding, whether it justifies the headaches. I do not believe, it does, not alone at least. You say headaches have started on 10 December, but that "small focus of gliosis" is not a recent event. A gliosis is what is left of an old injury, sort of like the scars on the skin, but in this case on the brain. So it has occurred way before the start of the headaches. Also it is too small to cause headaches anyway. As it is a scar it is not possible to tell precisely when it happened or why unfortunately.
The second finding is adenoid hypertrophy. That is a common finding in children. Its significance is that it can indicate a predisposition for upper respiratory infection like sinusitis.
The third finding is the high platelet count, thrombocytosis, very high indeed. Now that can be in the setting of a disease of the bone marrow which produces blood elements, called primary thrombocytosis. That would warrant genetic tests and bone marrow biopsy, usually with spleen enlargement, but since it is a condition which usually manifests much later in life and not in children it has been considered unlikely. What is more likely is for it to be secondary, meaning a reaction to another condition with widespread inflammation like vasculitis, inflammation of the blood vessels. So the doctors suggest that further tests are necessary to test in that direction, the possibility of vasculitis from a connective tissue disorder which might also explain that previous ischemic focus.

So to resume I would list 3 possible causes for your son's headaches: sinusitis, migraine and vasculitis. The first two are more benign ones.
Sinusitis would be more probable cause if he also has had nasal congestion and discharge and usually improves gradually with nasal decongestants, antihistaminics and at times antibiotics. For the pain medication like Ibuprofen.
Migraine which can cause headache with nausea and vomiting would need for the moment painkillers like Ibuprofen and if frequent headaches preventive treatment in the future. But the diagnosis of migraine can't be made in such a short time. It needs for other causes like vasculitits to be definitely excluded and observation of the episodes over the following months, so it's a diagnosis which should be put on hold for now until other possibilities have been excluded
Vasculitis in the setting of a connective tissue disorder is the third possibility and as I mentioned before should be investigated. Some of those tests are ESR, CRP (perhaps already done), antinuclear antibodies, rheumatoid factor, XXXXXXX antibodies, complement levels etc, your doctors in the report suggest they have already have suggested them and I believe them to be necessary as well. Also an evaluation of the spleen by at least an ultrasound would be reasonable in the setting of that platelet count.

I remain at your disposal for other questions

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Thank you for the additional information. Being only a carrier of beta thalassemia shouldn't cause any symptoms, such patients live a healthy life generally.

It is good that some tests have been done and will be completed with the others. Of course that you can write again with their results.

For the moment given the short history of the symptoms for only 10 days I would put sinusitis as more likely. Vasculitis has generally a more gradual course and the tests you mention till now do not support it either, but it should be investigateg completely given that small old focur as the thrombocytosis.

Looking forward to hearing from you soon.

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I read that MRI report carefully. As you yourself noticed there is sinus infection.

It is mild though. In theory it shouldn't cause such intense pain as is described. It remains a possibility as in children pain description can be a little subjective (even in adults for that matter), but if always so intense with intervals with no headache in between it is less likely and would be more in favor of migraine.

As for vasculitis it is inflammation involving blood vessels. Generally inflammation is a protective reaction, involving an accumulation of immune cells and release of their substances, but there are times when it can be abnormal, an abnormally increased immune response leading to damage of our own body tissue, in the case of vasculitis blood vessels. So it can lead in vessel damage in different part of the body, hence tissue damage due to interruption of blood supply. So when it is the case it requires long term treatment with drugs which suppress the immune system like corticosteroids.
However that being said, I wouldn't want you to panic, after you provided the values of the other lab tests (ESR, CRP etc), I do not think vasculitis that likely to be your case with them being normal and the onset of the symptoms not being typical. The small focus as I said is old and for all we know could've been there from infancy, a radiologic suspicion doesn't make the diagnosis. The rests of the brain imaging showed nothing wrong so as I said shouldn't be alarmed whether sinusitis or migraine it's not threatening.

I hope to have been of help.

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Normal values for lab tests may differ a little between laboratories, however the antibodies values seem normal.

As for the high platelet count, thrombocytosis, as I already explained it can be found temporarily elevated in the setting of a transitory infection or inflammation. But since the value is really high a repeat test is necessary in a couple of weeks from the first test (even in case she got back to normal). She is slightly anemic and with low iron which can cause some raise in the platelet count but not that high. If the repeat test is again that high then a myelogram should really be considered (an exam of the bone marrow).

For the headache you can also give Ibuprofen to ease the pain for now since Paracetamol is not effective, didn't mention before it as the hospital report said your daughter had got better.
As for what it is, as I said in the beginning, it can not be said with certainty for now. If all the tests come back normal including the platelet count then again the primary hypothesis remain migraine and sinusitis and migraine specific treatment can be tried, but only if the tests come back normal. If the headaches do not remit without a cause being found, the MRI should be repeated preferably with intravenous contrast this time to see whether there are new changes and a lumbar puncture should be done as well.
I understand all this might seem a little overwhelming, but at times cases are not clear cut and observation and repeat exams are necessary, for now the good thing is nothing on that first MRI represented an immediate threat.

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Hello! I am glad to hear that the headache is getting better. The urine analysis indicates a urinary infection which should be treated with antibiotics. It may perhaps explain the raised platelet count although as I've said before such a high value should be followed with control blood counts in a few weeks.

As for possible relation between the headache and the high platelets, a high platelet count can be associated with a risk of stroke, blockage of blood vessels, which may manifest with headache.
However it would have been manifest on the MRI so that shouldn't be your daughter's case.
One particular type of thrombosis, venous thrombosis, which manifests with headache and vomiting, might be missed with the type of non-contrast MRI she's had which is why if you read back our exchange I said to have another MRI but with contrast this time to check for that diagnosis. Since the headache is getting better though it might not be necessary.

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Brief Answer:
Platelet count is normal.

Detailed Answer:
Thank you for the update.

That number is completely normal. That is great news, it rules out a primary thrombocytosis, a bone marrow condition and would confirm that the high platelet count was secondary, a reaction to an infection or inflammation. Haemoglobin is ok as well in a beta thalassemia carrier it is expected to be on the borderline. So that tests is a good thing.

Hopefully with the given antibiotics the urinary infection will be resolved. I still would recommend another blood count after a month or so to make sure.

Wishing you and your family good health.

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