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 pressure-like, located mostly everywhere. Severity is rated as quite severe. It is precipitated by homework, worse after a long day. It is alleviated by resting in a dark room with some improvement. There is no associated fever. The patient is also experiencing a lot of worry about friends. Parents report that he has not experienced any trauma. Family history is positive for migraine and panic attacks in older sibling. Social history reveals risk taking behaviours. Physical Examination: The child appears ill at ease and is alert and oriented. Head and neck exam: Neck is supple with full range of motion, Cranial nerves are intact. Focused neurological exam: Motor exam shows strength 5/5 with no pronator drift. Reflexes are 2+ throughout. 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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