• Heart Failure
  • Cardiovascular Clinical Consult
  • Adult Immunization
  • Hepatic Disease
  • Rare Disorders
  • Pediatric Immunization
  • Implementing The Topcon Ocular Telehealth Platform
  • Weight Management
  • Monkeypox
  • Guidelines
  • Men's Health
  • Psychiatry
  • Allergy
  • Nutrition
  • Women's Health
  • Cardiology
  • Substance Use
  • Pediatrics
  • Kidney Disease
  • Genetics
  • Complimentary & Alternative Medicine
  • Dermatology
  • Endocrinology
  • Oral Medicine
  • Otorhinolaryngologic Diseases
  • Pain
  • Gastrointestinal Disorders
  • Geriatrics
  • Infection
  • Musculoskeletal Disorders
  • Obesity
  • Rheumatology
  • Technology
  • Cancer
  • Nephrology
  • Anemia
  • Neurology
  • Pulmonology

Seen in the ED: A Different Kind of Headache


A woman in her 50s who has a history of tension headache presents to the ED with a headache different from any she has had. Mild photophobia is the only finding on physical exam. Your dx?

Patient history. A woman in her 50s with a history of frequent tension headaches presents to the emergency department (ED)for a bad headache. She states this headache is different than her normal ones because it came on suddenly and she vomited twice. The location of the pain is also atypical for her—most severe in the back rather than under her temples. She denies any difficulty with speech, vision, strength, or coordination or other complaints.

Vital signs. Vital signs are normal except for a BP of 177/94 mm Hg.

Physical examination. Physical exam is normal except for mild photophobia with a bright light.

Imaging. Results of head CT, below.

What is the most likely diagnosis?

A.  New onset migraine

B. Cerebellar stroke

C. Meningitis

D. Cerebral aneurysm

Subarachnoid Hemorrhage from the Emergency Medicine 1-Minute Consult Pocketbook

Find myriad puzzling presentations in more of Dr Pregerson's "Seen in the ED" cases.

Related Videos
Primary Care is the Answer to the Migraine Care Gap, Says Headache Specialist
Migraine Management Pearls for Primary Care with Neurologist Jessica Ailani, MD
© 2024 MJH Life Sciences

All rights reserved.