All Journals from Adnan Azim
A previously fit and healthy 57 year old gentleman presented to hospital 2 weeks after a previous admission with acute severe headache. At the time of his previous admission the patient had reported that the headache was preceded by an unprovoked sharp pain in his back which had quickly resolved. The headache developed a few hours later and was noted to be markedly worsened by any attempt to sit upright, accompanied by intense nausea, and relieved by lying flat.
Discussion
Severe headaches are a frequent presentation to the Emergency Department, accounting for around 1% of presentations. Of these, 13-16% will have a sinister underlying pathology but accurate diagnosis of headaches on the medical take remain difficult for non-specialists. A retrospective study from the UK found that, of those presenting to Emergency Department with sudden onset severe headaches, only 60% were given a specific headache diagnosis, with one third of these given their diagnoses despite an inadequate history.