Certainly. Below is a comprehensive, structured treatment plan for **Mr Patient**, a 13-year-old male presenting with headache, based on the information provided and standard clinical guidelines. This plan assumes no red flags or abnormal findings are present. If any red flags arise, immediate escalation and further workup are required.

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## 1. Primary Diagnosis

**Provisional Diagnosis:**  
*Primary headache disorder* (most likely migraine or tension-type headache), pending further history and examination.

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## 2. Treatment Goals

- Relieve acute headache symptoms
- Prevent recurrence or reduce frequency/severity of headaches
- Minimize medication side effects and avoid medication overuse
- Identify and manage potential triggers
- Exclude secondary causes, especially those requiring urgent intervention
- Maintain normal school, social, and physical activities

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## 3. Medication Recommendations

**A. Acute Treatment (as needed for headache attacks):**

- **Acetaminophen (Paracetamol):**  
  - Dose: 10–15 mg/kg orally every 4–6 hours as needed (maximum 75 mg/kg/day or 4 g/day, whichever is lower)
- **OR Ibuprofen:**  
  - Dose: 10 mg/kg orally every 6–8 hours as needed (maximum 40 mg/kg/day or 2.4 g/day, whichever is lower)
- **Consider triptans** (e.g., sumatriptan nasal spray 5–20 mg, max 40 mg/day) *if diagnosis of migraine is confirmed and OTC analgesics are ineffective; only under specialist supervision in pediatric patients.*

**B. Preventive (Prophylactic) Treatment:**  
- Not indicated unless headaches are frequent (≥4/month), disabling, or unresponsive to acute therapy.
- Options (to be initiated by a specialist):  
  - Amitriptyline, topiramate, or propranolol (dosing and selection individualized; not started without specialist input).

**C. Duration:**  
- Acute medications: Use at onset of headache, limit to ≤2–3 days/week to avoid medication overuse headache.

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## 4. Non-Pharmacological Interventions

- **Lifestyle modifications:**
  - Maintain regular sleep schedule
  - Hydration: Encourage adequate fluid intake
  - Regular meals, avoid skipping breakfast
  - Limit caffeine and avoid known dietary triggers
  - Encourage regular physical activity
- **Headache diary:**  
  - Record frequency, duration, severity, potential triggers, and response to treatment
- **Stress management:**  
  - Relaxation techniques, cognitive behavioral therapy (CBT) if stress or anxiety is a factor
- **Screen time:**  
  - Limit excessive use of screens/devices

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## 5. Follow-up Schedule

- **Initial follow-up:** 2–4 weeks after starting treatment or sooner if symptoms worsen
- **Subsequent follow-up:** Every 2–3 months, or as needed based on symptom control
- **Urgent review:** If red flag symptoms develop

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## 6. Monitoring Parameters

- Headache frequency, severity, and duration (via diary)
- Medication use (to avoid overuse)
- Side effects of medications
- School attendance and participation in activities
- Signs of secondary headache/red flags

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## 7. Patient Education Points

- Most headaches in adolescents are benign and manageable
- Importance of regular routines (sleep, meals, hydration)
- Avoid overuse of pain medications
- Recognize and report red flag symptoms (see below)
- Use headache diary to help identify triggers and monitor progress
- When to seek immediate medical attention

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## 8. Potential Complications to Watch For

- **Medication overuse headache** (from frequent analgesic use)
- **Progression to chronic daily headache**
- **Impact on school performance and psychosocial well-being**
- **Development of secondary headache** (if underlying cause missed)
- **Adverse effects from medications** (e.g., GI upset, drowsiness)

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### **Red Flags (Seek Immediate Medical Attention if):**

- Sudden, severe ("worst ever") headache
- Headache with fever, neck stiffness, photophobia
- Altered consciousness, seizures, focal neurological deficits
- Persistent vomiting, visual changes, papilledema
- Headache worse with lying down or Valsalva
- Headache after head trauma
- Headache waking from sleep or worse in the morning

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**Note:**  
This plan should be individualized based on further clinical assessment and test results. Consultation with a pediatrician or pediatric neurologist is recommended for diagnostic uncertainty, frequent or severe headaches, or if preventive therapy is considered.

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**References:**  
- American Academy of Neurology/American Headache Society Guidelines (2019)
- NICE Clinical Knowledge Summaries: Headache – children (2022)
- UpToDate: Approach to the child with headache (2023)

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**Always consult a healthcare professional for diagnosis and tailored management.**