Written by:
Genevieve D’Souza, MD
Stanford University

A 16 year old boy presents to the pediatric chronic pain clinic with 5 month history of daily headaches. Onset of headaches correlated with the start of 9^th grade in a new high school. His headache is in the occipital area radiating to the top of his head bilaterally. His grades have dropped significantly as he is absent 2-3 days/week and comes home early from school the other days. He reports being stressed from missing all the school work and now having to make up all the work. He reports difficulties in falling asleep and is playing videogames for 2-4 hrs at night as he can’t fall asleep. He was trialed on triptans and gabapentin but had to discontinue them due to side effects.  Review of the chart reveals a normal MRI of the head. On examination, he has a normal neurological exam with positive bilateral occipital neuralgia. He has been taking acetaminophen every 4 hours and ibuprofen every 6 hours, in scheduled fashion.  

Which option would not be the recommended next step in management?