A 15-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 aching, located mostly everywhere. Severity is rated as quite severe. It is precipitated by school, worse after physical exertion. It is alleviated by resting in a dark room with some improvement. There is no associated fever. The patient is also experiencing nausea. Parents report that she bumped their head 2 weeks ago. Family history is positive for depression in uncle. Social history reveals decline in school performance. Physical Examination: The child appears anxious and is alert and oriented. Head and neck exam: Neck is supple, Cranial nerves are normal. Focused neurological exam: Motor exam shows equal strength bilaterally. Reflexes are 2+ and symmetric in all extremeties. 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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