The chronic progressive headache deserves prompt medical attention, especially in the setting of an abnormal neurologic examination as it most often indicates an elevation in intracranial pressure (ICP) or significant intracranial pathology. Any child with a headache that is increasing in severity and has an abnormal neurologic examination needs emergent imaging. Worsening of headache severity by lying flat should raise the suspicion of increased ICP. Headache is present in half the children presenting with brain tumor, but it is almost always associated with an abnormal neurologic examination.6 Idiopathic intracranial hypertension (IIH), previously known as pseudotumor cerebri, is another common cause of chronic progressive headache that can also have accompanying abducens (sixth cranial nerve) palsy, decreased visual acuity, visual obscurations, decreased visual fields, or ringing in the ears.7 Papilledema in the setting of an elevated CSF opening pressure with normal neuroimaging, serum, and CSF studies confirm the diagnosis of intracranial hypertension. When increased ICP is found, a search for contributing factors such as mastoiditis, sinus venous thrombosis, cryptococcus, lyme meningitis, chronic meningitis, or medications (oral contraceptives, tetracycline, Retin-A, chronic steroid use) should be undertaken. Children with cerebral venous thrombosis commonly present with both systemic symptoms and focal neurologic signs.8 Risk factors for cerebral venous thrombosis include head and neck infections, acute systemic illness, dehydration, iron-deficient anemia, chronic systemic disease (e.g., connective tissue, hematologic, cardiac, or oncologic), or prothrombotic states.8,9