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Child or adolescent with a headache

Clinical Discipline(s)/Organ System(s)
General Practice, Paediatrics, Psychiatry/Health Psychology
Progress Test Topic(s)
Mental health
Description
A mother brings her 8 year old NZ European/Chinese boy to their GP because of headache. This has been present for 4 months and is particularly severe when he gets home from school. He is unable to describe the character of the pain and experiences them most days. He is missing at least 2 days of school each week. He has no other systemic symptoms.
Applied Science for Medicine 
   - Normal growth and development
   - Pharmacology of medications used in management of pain and migraine; paracetamol
Clinical and Communication Skills 
   - Recognise headaches that require urgent management (young age, associated meningism and/or focal neurology, associated vomiting, developmental regression, personality change)
   - Physical examination including height and weight, blood pressure, visual acuity, fields and fundoscopy
   - Assess for anxiety and depressive symptoms
   - Assess for other medically unexplained somatic symptoms
   - Understand the importance of psychosocial factors in precipitating/maintaining chronic and recurrent headaches
   - Perform a HEADSS assessment in adolescent/older child
Personal and Professional Skills 
   - Evaluation of social, emotional and school history (any emotional or family/whānau stressors)
   - Understand how family/whānau and school dynamics can influence behaviour
   - Communicate empathetically with child and caregivers including talking to older children/adolescents without parents present
   - Consent and assent
Hauora Māori 
   - Understand context of educational inequities for Māori children: potentially relevant to both aetiology (e.g. discrimination) and effects (absenteeism more of an issue among Māori children, impacts on educational achievement)
   - Acknowledgement of the disproportionate impact of illness on whānau employment/income, and therefore availability and models of caregiving
   - Consideration of access to cultural/spiritual support for patient and whānau
Conditions to be considered relating to this scenario
Common
intercurrent infections, tension headaches, migraine, sinusitis, anxiety/depression, family dysfunction
Less common but 'important not to miss'
meningitis, intracranial bleeding, brain tumour, benign intracranial hypertension
Related Scenarios
[Headache]