A 15-year-old boy 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 8 out of 10. It is precipitated by stress, worse after physical exertion. It is alleviated by ibuprofen with some improvement. There is no associated fever. The patient is also experiencing dizziness. Parents report that he bumped their head 2 weeks ago. Family history is positive for bipolar disorder in father. Social history reveals bullying at school. 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 good tone and strength bilaterally. Reflexes are 1+ in the lower limbs and 2+ in the upper limbs. 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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