Razdan et al. Journal of Medical Case Reports 2011, 5:77 http://www.jmedicalcasereports.com/content/5/1/77 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access New-onset headache in an elderly man with uremia that improved only after correction of hyperphosphatemia (“uremic headache”): a case report Sushil Razdan1, KK Pandita1*, Vanilla Chopra2, Sanjay Koul3 Abstract Introduction: New-onset headaches in the elderly are usually secondary and rarely primary. We present the case of an elderly man with recent-onset headache due to uremic hyperphosphatemia and hypocalcemia. To the best of our knowledge, this is the first case report of its kind in the literature. Case presentation: We present the case of a 70-year-old Indian man with chronic kidney disease whose new- onset headache improved only when his hyperphosphatemia and hypocalcemia were corrected. He had diffuse, dense calcification of tentorium cerebelli and falx due to hyperphosphatemia. Conclusions: This case report reinforces the importance of identifying the cause of a new-onset headache, particularly in the elderly, and treating it before blaming a tension headache or primary headache as the cause. Introduction Although the prevalence of headache is reduced with age, it remains a common problem in the elderly [1]. New-onset primary headaches are a rarity in this age group [2]. Appropriate identification of secondary cause of a headache is the key to successful therapy. We pre- sent an elderly patient with chronic renal failure (CRF) with hyperphosphatemia whose new-onset headache improved only with correction of hyperphosphatemia and hypocalcaemia. Case presentation A 79-year-old Indian man, who had CRF due to hyper- tensive nephropathy for the past five years, presented with new-onset headache for the past six months. The headache was global, of moderate to severe intensity, dull in character, persistent, and occurred daily. It had no relation to coughing, straining, or posture change. It had no diurnal variation. He had a history of occasional vomiting. For the past approximately one year, he had * Correspondence: panditakk@yahoo.co.in 1Department of Medicine, ASCOMS, Sidhra, Jammu, J&K, India Full list of author information is available at the end of the article symptoms suggestive of restless-leg syndrome. He had received maintenance hemodialysis for more than one year. He had no history of scalp tenderness, jaw claudi- cation, persistent fever, neck pain, persistent nasal symp- toms, or dental disease. No history of any obvious trauma was found. He had received sertraline, gabapen- tin, sodium valproate, and topiramate for the headache, with no benefit. The headache was not relieved even by non-steroidal anti-inflammatory drugs (NSAIDs). On examination, he had mild pallor, blood pressure of 130/88 mm Hg, and a sallow complexion. The rest of his general examination and systemic examinations were unremarkable. He had no neurologic deficit. His neck was supple. Fundus examination revealed no papilloe- dema. Plain CT scan of his head revealed diffuse, dense calcification of the cerebellum, tentorium (Figure 1), and falx. He had a hemoglobin level ranging from 9 to 11 mg/dl (with erythropoietin; normal range (NR), 13.6 to 17.5 gm/dl), erythrocyte sedimentation rate (ESR) of 20 mm, first hour (NR, 0 to 15 mm, first hour). Blood urea level ranged from 140 to 198 mg/dl (NR, 8 to 40 mg/dl), and serum creatinine level ranged from 6 to 9.6 mg/d (NR, 0.6 to 1.2 mg/dl); serum calcium level ranged from 7.4 to 8.2 mg/dl (NR, 8.5 to 10.5 mg/dl), © 2011 Razdan et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.