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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.

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Authors

Dr. Karen Forbes

Dr. Jade Hindie

jade.hindie@umontreal.ca

Reviewer

Dr. Hosanna Au