An 8-year-old girl with headache and syncope.

An 8-year-old black female with hypertension and insulin resistance presents to the emergency department with a severe headache and fainting episode. She reports that she has had headaches over the past few days that have been treated with ibuprofen, but had sudden onset of a severe headache while standing up giving an oral presentation at school today. Her teacher allowed the patient to sit down at her desk, and she does not recall anything after sitting down. Her teacher reported that as soon as the patient sat down, her head fell to her desk. Then she “awoke” a few seconds later, complaining of a severe headache. On further questioning, the patient characterizes the headache