Helpful memo from a consultant on SAH: Don’t be fooled by the pain improving rapidly. This can happen with an SAH. If the patient describes a ‘worst ever’ headache coming on suddenly & becoming maximal over a few minutes, admit them for urgent investigation even if it’s improved.
Exceptions to this rule:
- If the pain literally improves within seconds, it’s probably OK.
- If the patient is getting recurrent episodes of similar pain with similar triggers (e.g. post-coital) and an episode has already been investigated and proved negative, they don’t have to be investigated every time.
- If they describe an episode that occurred two weeks or more ago, CT and LP are not likely to find anything helpful and referring them to neurology outpatients is a better route.