1. A 13-year-old girl comes to the pediatrician’s office for evaluation of her headaches. The headaches began sometime in elementary school but have worsened over the last year. She notes that school is a stressor, and her parents are currently in the middle of a divorce, which is also contributing to her stress. She describes her headaches as mild to moderate in intensity, pressure like, occurring on average every other day, if not daily, (15-20 days a month) and lasting for hours to even days. She sometimes experiences photophobia but has no nausea or vomiting. Although she feels her school performance is affected, her grades are A's and B's. Based on the above information, what is her likely diagnosis?
2. You follow a 15-year-old girl in your office for frequent tension-type headaches. She is a bright student who performs very well in school. Initially, you recommended lifestyle modifications, including hydration, timely meals, and sleep hygiene, which she is diligently following. However, she continues to experience frequent headaches, and despite these efforts, the frequency appears to have increased. She is now ready to try some new strategies. What would be reasonable next steps in managing her frequent tension-type headaches? (Multiple answers may be correct)
