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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 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.

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Authors

Dr. Karen Forbes

Dr. Jade Hindie

jade.hindie@umontreal.ca

Reviewer

Dr. Hosanna Au