A 12-year-old girl presents with concerns of headache. Parents report that the child has been complaining of headaches for the past 7 months. The headache is described as throbbing, 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 acetaminophen with some 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 anxiety in grandmother. Social history reveals decline in school performance. Physical Examination: The child appears anxious and is alert and oriented. Head and neck exam: Neck is mobile, Cranial nerves are intact. Focused neurological exam: Motor exam shows equal strength bilaterally. Reflexes are 2+ throughout. Sensory exam is intact to light touch. Cerebellar testing shows no abnormalities. Gait is normal heel-toe walk.
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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