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Background and Aims Medulloblastomas are one of the most common malignant brain tumours in the paediatric population. Originating from the cerebellum, they have the potential to spread to other areas of the central nervous system, and can be very aggressive. Symptoms can be particularly debilitating in the terminal period, with refractory headaches, nausea and vomiting, and altered mental status that adversely affect the patient‘s quality of life.

Methods We present the case of a 5-year-old boy with terminal medulloblastoma who was referred to the paediatric pain team for symptom relief. He had undergone surgical resection followed by adjuvant chemoradiotherapy prior to this but experienced an eventual relapse of the disease. The oncological team had assessed his disease to be terminal with a palliative intent of treatment. The main symptom that was causing him significant distress was severe headaches throughout the day that was refractory to conventional treatment modalities.

Results He was already on high doses of multiple analgesia, including morphine, ketamine and clonidine. However the intensity of his headaches persisted while the side-effects of these medications were becoming increasing pronounced with drowsiness, nausea and vomiting. As a result of this, he was either very drowsy or in severe pain most of the time, which limited his function and quality of life. After a multi-disciplinary discussion with the palliative team, a tailored analgesia plan was introduced which included opioid rotations and methadone.

Conclusions Terminal medulloblastoma can be particularly debilitating. A comprehensive multi-modal analgesia plan should aim to limit adverse effects of drugs to maximise quality of life.