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A 15 year old girl presents to the in the forehead with concerns of headache. Parents report that the child has been complaining of headache for the past 5 months. The headache is described as dull, located mostly in the forehead. Severity is rated as 9 out of 10. It is precipitated by school, worse after a long day.  It is alleviated by ibuprofen with some improvement. There is no associated fever. The patient is also experiencing fatigue. Parents report that she has not bumped their head.  Family history is positive for bipolar disorder in mother. Social history reveals recent death of a grandparent. Physical Examination:  The child appears visibly worried and is alert. Head and neck exam: Neck is normal, Cranial nerves are normal. Focused neurological exam: Motor exam shows equal strength bilaterally. Reflexes are 1+ in the lower limbs and 2+ in the upper limbs. Sensory exam is intact to light touch. Cerebellar testing shows no abnormalities. Gait is normal heel-toe walk.

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Authors

Dr. Karen Forbes

Dr. Jade Hindie

jade.hindie@umontreal.ca

Reviewer

Dr. Hosanna Au