A 14-year-old girl presents with near constant frontal headaches of a month’s duration. The pain is dull and worsens with Valsava’s maneuver. Her parents say she is she is irritable and moody. The patient says she has recently gained a significant amount of weight. Eye examination reveals papilledema. CT imaging of her brain is normal.
New onset continuous headache is an uncommon symptom in childhood and warrants thorough neurologic and ophthalmic examinations. It is notable that the patient’s headaches worsen with activities that raise intracranial pressure. The alteration in mood and personality and weight gain may suggest depression—a comorbidity commonly associated with migraine headaches and chronic pain syndromes. The presence of papilledema, however, makes this case a neurologic emergency.
What tests would you order to reach a diagnosis?