A 7-year-old presents with morning headaches, vomiting, and papilledema. What are the immediate concerns and initial steps?

• A. Dehydration; Give IV Fluids and Reassess
• B. Increased Intracranial Pressure; Obtain Urgent MRI and Consult Neurosurgery/Neurology
• C. Migraine Without Aura; Treat With Analgesics
• D. Tension-Type Headache; Observation

Answer: (B)

Morning headaches with vomiting and papilledema signal raised intracranial pressure in a child, which is a medical emergency until proven otherwise. The lucid clue here is papilledema—the optic disc swelling results from sustained high pressure inside the skull, not from a simple migraine or tension headache. In a 7-year-old, this pattern raises concern for a space-occupying lesion, hydrocephalus, or other causes of increased ICP that can worsen rapidly.

The immediate action is to get urgent imaging to identify the cause and guide next steps. An MRI provides detailed information about brain structures, masses, and ventricular status, helping clinicians plan appropriate treatment. Early involvement of neurosurgery is essential because many ICP-related conditions require surgical management, such as tumor resection, ventricular drainage, or shunting. Neurology teams coordinate further evaluation, medical management of ICP, and the overall care plan.

This approach differs from attempting dehydration therapy or treating as a routine migraine or tension-type headache, which would not address the underlying raised ICP and could delay critical intervention. Lumbar puncture is avoided before imaging in suspected ICP elevation due to the risk of brain herniation.