A 11-year-old boy presents with concerns of headache. Parents report that the child has been complaining of headaches for the past 9 months. The headache is described as aching, located mostly all over. Severity is rated as 8 out of 10. It is precipitated by school, worse after physical exertion. It is alleviated by resting in a dark room with minimal improvement. There is no associated fever. The patient is also experiencing dizziness and fatigue. Parents report that he has not lost consciousness. Family history is positive for migraine and panic attacks in older sibling. Social history reveals bullying at school. Physical Examination: The child appears ill at ease and is alert and oriented. Head and neck exam: Neck is supple, Cranial nerves are normal. Focused neurological exam: Motor exam shows strength 5/5 with no pronator drift. Reflexes are 2+ throughout. Sensory exam is intact to light touch. Cerebellar testing shows no abnormalities. 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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