Sudden severe headaches which subside

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:

  1. If the pain literally improves within seconds, it’s probably OK.
  2. 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.
  3. 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.

About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Credits 2012, Emergency Medicine, Neurology. Bookmark the permalink.

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