“Troubling headache….” Case Conclusion June 6, 2012
Posted by Andy Jagoda, MD in: Neurologic, Radiology , trackback
Your second patient was more concerning. Although she had a known primary headache disorder, she described several red-flag features, including nuchal rigidity and pain worst at onset. You recalled a popular headache review paper that highlighted the danger of assuming all headaches in patients with known migraines are benign. You decided to order neuroimaging and, while waiting, moved on to another patient.
Later as you were printing out the discharge paperwork for some other patients, you examined the CT head from your first patient and were surprised to find blood in the basal cisterns. You took a deep breath – thankfully, you did not just refill her prescription.
Congratulations to Dr. Achacoso, Dr. Noman, Dr. Dibartolo, Dr. Sisson, and Dr. Peschanski— this month’s winners of the exclusive discount coupon for Emergency Medicine Practice. For an evidence-based review of the etiology, differential diagnosis, and diagnostic studies for Acute Headaches in the ED, purchase the Emergency Medicine Practice issue.