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Sudden onset severe headache

Clinical Discipline(s)/Organ System(s)
Emergency Medicine, Nervous System, Neurosurgery
Progress Test Topic(s)
Neurological
Description
A 45 year old NZ European woman presents to the Emergency Department with the worst headache of her life. She was sitting at home watching the television and the headache came 'out of the blue'. She is now in the resuscitation room and finds the light very uncomfortable. Her blood pressure is noted to be 180/120 mmHg.
Applied Science for Medicine 
   - Anatomy of the head, neck and brain
   - Pathophysiology of hypertension
   - Classify the different types of intracranial bleeds
   - Current hypotheses explaining migraine
   - Pharmacology of thiazide diuretics, ACE inhibitors, angiotensin II receptor antagonists, alpha adrenoceptor blocking drugs, centrally acting antihypertensives, calcium channel blockers, opioids, metoclopramide, domperidone, ondansetron, scopolamine
Clinical and Communication Skills 
   - History from a patient with a headache; recognise a migrainous aura and subarachnoid haemorrhage
   - Examination of the neurological system; recognise meningism
   - Perform assessment of level of consciousness using Glasgow Coma Score (GCS)and Alert, Voice, Pain, Unresponsive (AVPU) Scale, fundoscopy, lumbar puncture
   - Differential diagnosis of headache
   - Indications for CT scan, CT angiogram, MRI and MR angiogram
   - Interpret full blood count, coagulation screen, pathology report on cerebrospinal fluid (CSF)
   - Management of migraine (including preventive strategies) and benign headache (pharmacological and non-pharmacological); consider contraceptive needs of reproductive age woman with migraine and aura
   - Outline the management of subarachnoid haemorrhage: conservative, medical, interventional radiology, neurosurgery
   - Management of hypertensive crisis
   - Prognosis of intracranial bleeds
   - Role of neurosurgical and stroke team
Personal and Professional Skills 
   - Managing your stress when dealing with an urgent situation/unwell patient
   - Competence and consent
Hauora Māori 
   - Higher incidence of stroke and stroke risk factors (including hypertension) for Māori
   - Inequities in stroke outcomes for Māori
Population Health 
   - Epidemiology, risk factors, prognosis for stroke
   - Stroke services
   - Epidemiology of intracranial bleeding
Conditions to be considered relating to this scenario
Common
tension headache, migraine, subdural haemorrhage
Less common but 'important not to miss'
subarachnoid haemorrhage, meningitis, encephalitis, intracranial neoplasia
Uncommon
idiopathic intracranial hypertension, cluster headache, trigeminal neuralgia, post-coital headache, vasculitis, venous sinus thrombosis
Related Scenarios
[Headache], [Fever and headache]