What should be the immediate next step for a 7-year-old male showing increased headache frequency and symptoms of possible neurological involvement?

In cases where a child presents with an increased frequency of headaches alongside symptoms suggestive of neurological involvement—such as vision changes, balance issues, or altered mental status—immediate further evaluation is essential. An MRI of the brain is the preferred next step in this scenario because it provides detailed imaging of the brain structure and can help identify underlying pathologies that may be contributing to the headaches and potential neurological symptoms.

Conditions such as tumors, cysts, or other structural anomalies can lead to increased intracranial pressure or direct involvement of brain tissues, which an MRI is well-equipped to detect.

While a CT scan might also be considered in some settings, particularly in cases of acute onset headache with red flags, an MRI is generally more sensitive and appropriate for chronic symptoms and for assessing subtle changes in soft tissues of the brain. Referral to a psychologist would not address the immediate concern of potential neurological involvement, and a trial of analgesics would not be justified without understanding the underlying cause of the headaches. Immediate neurological evaluation through imaging is crucial to ensure safe and appropriate management.