Secondary headache and raised intracranial pressure — structured clinical encounter

A fourteen-year-old girl is referred to your general paediatric clinic with a three-month history of daily headache. The headache is present on waking, is described as a pressure across her forehead, worsens when she bends or strains, and is accompanied by early-morning nausea. Over the last month she has had episodes of her vision greying out when she stands up quickly, a whooshing sound in her ears in time with her pulse, and new horizontal double vision. Her body mass index is well above the ninety-fifth centile, she takes minocycline for acne, and her mother has type two diabetes. On examination her blood pressure is normal, her neurological examination is normal apart from a bilateral sixth-nerve palsy, and fundoscopy shows bilateral optic-disc swelling with blurred margins.