55 yo woman with sudden onset HA
Richard Saporito, DC, DABCO
A 55 year old Caucasian woman present with sudden onset, severe headache. She states that the headache began the previous morning. She states she had a mild headache the night before and awoke yesterday with the low level pain still present. When she got up out of bed the headache became severe. She had hoped that bed rest would relieve the pain and lying down did provide some palliative relief. When she arose to use the bathroom, however, the pain rapidly became intolerable again. There is no change in the pain level this morning. She reports also having moderate bilateral neck pain, nausea and, “just wants to sleep all day.” During the history the patient seemed inattentive and drowsy. She reports having had headaches in the past but nothing nearly this severe. Typically the headaches were brought on by fatigue or stress.
The patient is currently under your care for lumbar pain secondary to degenerative joint disease. Her history is significant for mild hypertension and hypercholesterolemia. She has been on a statin and an angiotensin receptor blocking medications for several years. There have been no recent changes. There is no history of recent trauma.
Question: Based on the history what are some differential diagnoses you are considering?