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Constant Headache, Weight Gain, and Papilledema in a Teenage Girl

Frontal headaches of a month’s duration trouble this 14-year-old girl. The pain is dull and worsens with Valsava’s maneuver.. She has gained weight recently, and shows papilledema.

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.

Are there red flags, in addition to papilledema, that raise your suspicion? What tests would you order to reach a diagnosis?

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