A 11-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 8 out of 10. It is precipitated by school, worse after physical exertion. It is alleviated by acetaminophen with minimal improvement. There is no associated fever. The patient is also experiencing dizziness. Parents report that he has not experienced any trauma. Family history is positive for anxiety in uncle. Social history reveals risk taking behaviours. Physical Examination: The child appears ill at ease and is alert and oriented. Head and neck exam: Neck is supple with full range of motion, Cranial nerves are intact. Focused neurological exam: Motor exam shows strength 5/5 with no pronator drift. Reflexes are 2+ and symmetric in all extremeties. 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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