Is it a migraine or something else?
This article describes the case of a 42-year-old female patient who presented to the emergency department with complaint of a splitting headache. The patient had a history of migraines, however, she claimed that this headache was quite different from the migraines she typically has. Compared to her migraines, the onset of pain was more rapid, accompanied with vomiting. The pain affected both her frontal and occipital lobes. Although there were no other symptoms of difficulty in speech and swallowing. Neither did she complain of abdominal pain or fever. The patient’s clinical presentation and investigations led to the diagnosis of subarachnoid hemorrhage causing the splitting headaches.
On examination, the patient’s pulse was 95 beats per minute and blood pressure 147/91 mm Hg. Physical examination further showed mild photophobia. Initial diagnostic tests including complete blood count and basic metabolic panel showed normal results.
Doctors advised a CT scan of the patient’s head, which was consistent with the diagnosis of subarachnoid hemorrhage (SAH).
A computed tomography (CT) scan of the patient’s head is also taken. Subarachnoid hemorrhage is a rare, however, life-threatening condition. It is more commonly seen in mid to late adulthood. The clinical presentation of SAH varies depending on the severity of disease. The headache may include symptoms of nausea, vomiting, photophobia, stiff neck, focal neurological deficits and brief loss of consciousness.
Doctors managed the patient’s headache with antihypertensive medications to maintain the systolic blood pressure less than 140 mm Hg with administration of nimodipine and calcium channel blocker to improve the patient’s neurological outcomes. She was further referred to a neurosurgeon for surgically clipping and coiling the aneurysm.
Is It More Than Just a Migraine? Making the Correct Diagnosis https://www.clinicaladvisor.com/home/features/clinical-challenge/more-than-just-migraine-diagnosis/2/