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A 15 year old girl presents to the both sides with concerns of headache. Parents report that the child has been complaining of headache for the past 8 months. The headache is described as pressure-like, located mostly both sides. Severity is rated as moderate. It is precipitated by family conflict, worse after a long day.  It is alleviated by a cold cloth to the forehead with some improvement. There is no associated fever. The patient is also experiencing a lot of worry about friends. Parents report that she bumped their head 2 weeks ago.  Family history is positive for anxiety in older sibling. Social history reveals risk taking behaviours. Physical Examination:  The child appears anxious and is alert. Head and neck exam: Neck is normal, Cranial nerves are normal. Focused neurological exam: Motor exam shows good tone and 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 normal finger nose testing. 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