A 12-year-old boy presents with concerns of headache. Parents report that the child has been complaining of headaches for the past 3 months. The headache is described as pounding, located mostly in the forehead. Severity is rated as really bad. It is precipitated by homework, worse after a long day. It is alleviated by a cold cloth to the forehead with some improvement. There is no associated fever. The patient is also experiencing nausea. Parents report that he bumped their head 2 weeks ago. Family history is positive for migraine and panic attacks in uncle. Social history reveals recent death of a grandparent. Physical Examination: The child appears visibly worried and is alert. Head and neck exam: Neck is supple, Cranial nerves are normal. Focused neurological exam: Motor exam shows equal strength bilaterally. Reflexes are 1+ in the lower limbs and 2+ in the upper limbs. Sensory exam is normal. 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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