About This Case

This is a case of a fourteen year old girl with worsening headaches. The case covers four months, beginning with entries into her video diary ("vlog" or "video blog"). She explores several approaches to headache management in a series of encounters with health professionals.

Navigating this Case Site

The grid above introduces the principals of this case. Each person has their own color scheme as seen above which serves as a cue on the other pages of the site. Clicking on each person above will provide you with a brief description of them.

The Calendar tab at the top brings you to a page where the events of the case are presented chronologically. The Encounters tab brings you to a page where the events are sorted by encounter type. You can re-sort the encounters by clicking on the column headings.

The sidebar to the right of every page has materials which live outside the timeline of the case.

Items in the case are preceded by an icon indicating the media type the item links to. The icons and the media types they represent are as follows:

Text Document
Electronic Health Record E-Mail
Presentation Slides (some with video)

Study Questions for the Adolescent Headache Case

  1. What are special considerations for treatment of an adolescent with this condition, compared to an adult?
  2. What lessons about self-medication does this case teach?
  3. What migraine triggers should be considered in creating a management plan?
  4. How can the patient collaborate in managing her headaches?
  5. How does the patient's anxiety affect her symptoms and relate to her treatment?
  6. Why is non-pharmcologic treatment recommended in addition to treatment with medications?

Coach Philips

Coach Philips

John Philips has been teaching Science and Math in Morgan's school district for 34 years. He coaches volleyball and softball, and advises the drama club's stage and lighting crew. Three years ago he was recognized as Teacher of the Year at Morgan's school.



Morgan Smith is a 14-year-old high school freshman who has had increasing headache pain for several months. She is an A student, who is a very good athlete and also enjoys being in theatricals at school. She is well-liked and has a large group of friends who are into keeping video diaries. Sasha is her best friend.

Morgan's Mom

Morgan's Mom

Emily Smith is the mother of three children: Morgan, aged 14, and 10-year-old twins, Brian and Sandy. She and her husband have been married for 18 years. Her husband is a bank manager and she was a third grade teacher until Morgan was born. Since then, she has been a stay-at-home mom who is very involved in her children's activities including being a volunteer school aide and a frequent chaperone for school trips.

Community Pharmacist


David Hutchinson is a community pharmacist who has worked at the pharmacy in the Smiths' neighborhood for 8 years. He has a special interest in patient counseling and has developed brief handouts about self-care of common symptoms such as headache and difficulty sleeping. The handouts include non-pharmacologic approaches (such as sleep hygiene) as well as over-the-counter remedies. He also always includes a section titled, "When to call your doctor..."

Nurse Practitioner

nurse practitioner

Cyndi Grayson has been a pediatric nurse practitioner in neurology for the past 6 years. Prior to becoming a nurse practitioner, she was an office nurse for 5 years and a school nurse for 8 years. She is particularly sensitive to the issues involved in managing headache in the school setting. Working with Dr. Connolly to develop a comprehensive but adaptable approach, she has incorporated strategies that can be individualized to meet the needs of a particular student within a given school setting.



Dr. Connolly is a pediatric neurologist who has a special interest in migraine headache in children and adolescents. She has been practicing at the university medical center for 3 years since completing her fellowship training, which included an introduction to the use of complementary therapies in pain management. She and Cyndi Grayson, nurse practitioner, have developed a systematic approach to in-school management of headache.

School Nurse

school nurse-01

Karen Wilkes has been the nurse at Morgan's high school of 600 students for 2 years. Prior to that, she was a community health nurse in a nearby city for 15 years. The "Nurse's Office" consists of Ms. Wilkes' office, which has two visitor chairs as well as a refrigerator, a scale, and other equipment; a half bathroom; and a room with an exam table and a single bed separated by a curtain. An additional room, which once contained the exam table and equipment, was converted into a counseling office last year.

Behavioral Therapist

Behavioral Therapist

Dr. Hunt has a doctoral degree in clinical psychology. She has been in practice for 10 years at the university medical center. Part of her training included becoming a cognitive behavioral therapist, a skill that she has been teaching to psychology trainees since she joined the faculty. Her research is focused on how use of CBT can reduce the need for anxiolytics in the management of insomnia.



Dr. Ergil is a prominent licensed acupuncturist (LAc), who has taught acupuncture and the principles of Chinese medicine at several institutions over the past 30 years. He recently received a doctorate in Acupuncture and Chinese Medicine (DACM). Dr. Ergil sees patients with chronic intractable pain at the local VA hospital.

Biofeedback Specialist


Dr. Sahler is an adolescent medicine specialist who has received specific training in the use of biofeedback to manage anxiety in addition to chronic pain syndromes such as headache, abdominal pain, and joint and muscle pain. She has used biofeedback with patients as young as 10, but younger patients can sometimes benefit from the approach as well. She encourages patients to use mood rings or Biodots® to practice relaxation between computer-based sessions (see the Learn More section on Biofeedback).