A 13-Year-Old Girl With Headaches While Voiding

Abstract

Pediatric Emergency Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX. Presented during the Section on Emergency Medicine Emergi-Quiz Case Competition at the 2007 American Academy of Pediatric National Convention and Exposition, San Francisco, CA, October 2007 Reprint requests and correspondence: Cara Doughty, MD, Pediatric Emergency Medicine, Texas Children's Hospital, Baylor College o Medicine, 6621 Fannin MC 1-1481, Houston, TX 77030. (E-mail: cbdought@texaschildrenshospital.org) The patient is a previously well 13-year-old female who presents to the emergency department (ED) with intermittent headaches for 2 years. The headaches initially occurred sporadically but have progressed in frequency and severity for the past several months to daily headaches that occur after every void, beginning 1 minute after urination, remaining severe for about 3 minutes, then subsiding to a severity of 2/10 until subsequent urination. Two days before presentation, the headaches became more severe, localized to the occipital region, and were accompanied by nausea and tingling of her hands and feet. The patient reports photophobia, phonophobia, and palpitations during the headaches but does not describe an aura. She reports no vertigo, visual changes, fever, weight loss, upper respiratory symptoms, change in urinary frequency or amount, rash, or association with menstruation. She has no headaches with bowel movements. The patient has sought medical attention for these headaches in the past, and prior evaluation included computed tomography (CT) of the head without contrast, an electrocardiogram, Holter monitor, and thyroid studies, all of which were unremarkable. Her medical history is unremarkable, and she has had no hospitalizations or surgeries. She underwent menarche at age 12, and her last menstrual period was 3 weeks ago. She takes acetaminophen and ibuprofen as needed for pain. There are no known drug allergies. Her immunizations are current. The patient lives with her parents, 2 siblings, and a dog. She attends the seventh grade, is an A student, and likes school. There are no recent sick contacts. The patient has not traveled recently. The family medical history is positive for a cousin and an aunt with migraines. Her father had febrile seizures as a child. There is also a family history of diabetes mellitus, hypertension, and skin cancer. The physical examination revealed a well-appearing female in no acute distress. Vital signs included a temperature of 96.9°F, heart rate of 121 per minute,