5 days of 'all-over' headache, 3 days previously, peaked ove | Figure 1

forderit

Emergency Medicine

Case Summary

5 days of 'all-over' headache, 3 days previously, peaked over 1 hour, tight sensation over head/ eyes, with lacrimation, had one vomit on day 1, but not since, generally off food, complaining of phono/photophobia, severe bouts last several hours, sleeping lots, worsens/becomes more tolerable- at most painful 9/10 severity, at least painful 4/10, worse on standing up, eased on leaning forward, not particularly worse at any time of day, no recent contact sport/trauma, not anticoagulated, had 1g acetaminophen bd and 400mg ibuprofen bd on 2 separate days, not made much impact, no visual disturbance, no scalp/ temporal tenderness, no neck pain, doesn't normally suffer with migraines/headaches, not under the weather, afebrile, not otherwise unwell.

Discharged from ER, diagnosed with 'severe tension headache with migrainous features'.

Returning a day later with repeated vomiting. CT head shows large acute left sided subdural haematoma with significant midline shift and subfalcine herniation of left lateral ventricle. Life saved.

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