Emergency Medicine: Headache Assessment

What symptom is the patient experiencing that suggests the need for urgent investigation?

Which examination finding in this patient may indicate a possible meningeal irritation?

What is the most critical reason for performing a CT head scan in this scenario?

Which investigation would be least appropriate as the first-line assessment for this patient's symptoms?

What should be the primary concern when assessing a patient with significant neck stiffness and headache?

Presenting Symptoms

A 43-year-old female presents to the emergency department with a sudden onset, severe occipital headache
The headache has been present for one hour
She is photophobic and has neck stiffness

Most Appropriate First-line Investigation

CT head scan is the most appropriate first-line investigation in this scenario
It is important to rule out a possible subarachnoid haemorrhage, which can be identified on a CT head scan

Other Investigations

Lumbar puncture may be considered in cases where the CT head scan is normal but suspicion remains for subarachnoid haemorrhage
Carotid Doppler ultrasound (duplex) scan may be appropriate for patients with a history of stroke or transient ischemic attack, although it is not the most appropriate initial investigation for this patient
CT cerebral angiography is a more invasive procedure, and is not typically a first-line investigation for suspected subarachnoid haemorrhage
Skull X-ray is rarely used in the diagnosis of acute neurological emergencies, as it is not sensitive to detect most intracranial pathologies

This quiz focuses on the evaluation and management of a patient presenting with a sudden severe headache, symptoms indicating possible subarachnoid hemorrhage. It covers the most appropriate first-line investigations and differentiates between various diagnostic procedures. Assess your knowledge on the correct approach in emergency medicine settings.