A 12-year-old girl presents with concerns of headache. Parents report that the child has been complaining of headaches for the past 4 months. The headache is described as aching, located mostly all over. Severity is rated as quite severe. It is precipitated by family conflict, worse after physical exertion. It is alleviated by acetaminophen with some improvement. There is no associated fever. The patient is also experiencing a lot of worry about school. Parents report that she has not experienced any trauma. Family history is positive for bipolar disorder in father. Social history reveals recent death of a grandparent. Physical Examination: The child appears ill at ease and is alert and oriented. Head and neck exam: Neck is supple, Cranial nerves are normal. Focused neurological exam: Motor exam shows good tone and strength bilaterally. Reflexes are 2+ throughout. Sensory exam is normal. Cerebellar testing shows normal finger nose testing. 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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