Last updated on 24 Mar 2023 at 2:08 PM (Paed10)

Child or adolescent with a headache
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
 

  • Structuring framing and timing of primary care consultation

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