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A 15-year-old girl presents with concerns of headache. Parents report that the child has been complaining of headaches for the past 6 months. The headache is described as throbbing, located mostly both sides. Severity is rated as 8 out of 10. It is precipitated by deadlines, worse after physical exertion.  It is alleviated by a cold cloth to the forehead with minimal improvement. There is no associated fever. The patient is also experiencing nausea. Parents report that she has not bumped their head.  Family history is positive for bipolar disorder in older sibling. Social history reveals risk taking behaviours. Physical Examination:  The child appears tearful and is alert. Head and neck exam: Neck is mobile, Cranial nerves are normal. Focused neurological exam: Motor exam shows good tone and strength bilaterally. Reflexes are 2+ and symmetric in all extremeties. Sensory exam is normal. Cerebellar testing shows normal finger nose testing. Gait is normal.

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Authors

Dr. Karen Forbes

Dr. Jade Hindie

jade.hindie@umontreal.ca

Reviewer

Dr. Hosanna Au