Answer :USMLE step 2 Mcq 165:A 9 year old boy has a history of severe headaches over the last two years

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Correct Answer: C

Explanation:
What distinguishes migraine from most of the serious diagnoses is its ictal nature, with periods of normality. With slight variations, pediatric migraine is defined as Periods of normalcy accompanied by autonomic signs, which may include nausea, vomiting, photo/phonophobia, dizziness or pallor. An aura may be present, there may be relief from sleep and a positive family history of headache. Pediatric migraineurs often have bilateral headache, do not have auras and have a much shorter duration of each attack. In common migraine, no aura is present (90% of cases). In classic migraine, aura is present, and in complicated migraine, focal neurologic signs are present (ophthalomplegic, hemiplegic or basilar artery migraine). Migraine can be a frightening experience for both the child and parent. Often the pain is severe, and the symptoms associated with aura, if it occurs, can be upsetting. Symptoms may include dysarthria, paraesthesias, dizziness and visual and/or auditory disturbances. A specific feature of migraine in children is that often a few hours sleep is all that is needed to stop the attack.In older children (>7 years), biofeedback with relaxation techniques has shown some success in controlling symptoms. Maintaining regular meals (especially breakfast), getting enough sleep and sufficient, but not excessive, physical exercise are all recommended to minimise the risk of migraine attacks.


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