A 13-year-old girl presents with concerns of headache. Parents report that the child has been complaining of headaches for the past 8 months. The headache is described as pounding, located mostly everywhere. Severity is rated as really bad. It is precipitated by homework, worse after a long day. It is alleviated by acetaminophen with minimal improvement. There is no associated fever. The patient is also experiencing a lot of worry about friends. Parents report that she has not experienced any trauma. Family history is positive for depression in grandmother. Social history reveals decline in school performance. Physical Examination: The child appears anxious and is alert. Head and neck exam: Neck is mobile, 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 normal. Cerebellar testing shows normal Romberg. Gait is normal.
Blume, H.K. “Pediatric Headache: A Review.” Pediatrics in Review 33, no. 12 (November 30, 2012): 562–76. https://doi.org/10.1542/pir.33-12-562.
Bagnell, A.L. “Anxiety and Separation Disorders.” Pediatrics in Review 32, no. 10 (September 30, 2011): 440–46. https://doi.org/10.1542/pir.32-10-440.
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