# Persistent Refractory Headaches Following Non-alcoholic Wernicke’s Encephalopathy in a Teenager

## TL;DR

A teenager developed persistent headaches after recovering from a rare neurological condition caused by vitamin B1 deficiency.

## Contribution

This case highlights a possible new or underreported long-term effect of Wernicke’s encephalopathy in adolescents.

## Key findings

- The patient showed significant improvement in neurological symptoms after thiamine treatment.
- A persistent, treatment-resistant headache developed following recovery from Wernicke’s encephalopathy.
- This case suggests a potential novel sequela of WE that requires further clinical investigation.

## Abstract

Wernicke's encephalopathy (WE) is a neurological condition that presents with a clinical triad of ophthalmoparesis with nystagmus, confabulation, and ataxia. It is caused by thiamine deficiency (Vitamin B1), commonly associated with chronic alcoholism as well as non-alcoholic causes, and early diagnosis with prompt thiamine replacement is essential to prevent irreversible neurological damage. We report the case of a 17-year-old girl who lost 18 kg in one month due to aggressive dietary control without appropriate nutritional support and developed neurological signs that were consistent with WE. A clinical diagnosis of WE was made, and the patient was treated with intravenous and oral thiamine. She showed significant improvement in neurological symptoms, but also developed a new, persistent, refractory headache, which remained unresolved despite extensive pharmacologic and interventional headache treatments. Persistent headaches in the post-WE setting, as seen in this case, may represent a novel or underreported sequela that requires further research and clinical awareness.