Clinical Case Database / Category: Patient Management

The management of a patient with acute severe headache

Publication details

Dr Victoria Henderson, Dr Rebecca Butchart
Foundation Years Journal, volume 4, issue 5, p.24 (123Doc Education, London, May 2010)


A 50-year-old man presents to the A&E department with a severe headache. He says it came on abruptly about 5 hours ago while he was mowing the lawn and has persisted since. Paracetamol and ibuprofen have made little difference. He is normally healthy and has not experienced headaches of this intensity in the past.

He has had one episode of vomiting since the headache started, but is otherwise feeling quite well. His neurological examination is normal, with no focal signs, and he is alert and orientated. He says that the headache came on very suddenly, was immediately very severe and was the worst headache he has ever experienced.

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Dr Victoria Henderson

Specialist Registrar in Acute Medicine
Royal Hampshire County Hospital
Romsey Road, Winchester

Dr Rebecca Butchart

Consultant in Acute Medicine
Royal Hampshire County Hospital
Romsey Road, Winchester


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3.  Cruickshank A, Auld P, Beetham R, et al. (2008) Revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage. Ann Clin Biochem, 45:238–244.

4.  Cruickshank A (2001) CSF Spectrophotometry in the Diagnosis of Subarachnoid haemorrhage. J Clin Pathol, 54:827–830.

5.  Hill S, Pinto A (2006) Cerebrospinal fluid analysis in suspected subarachnoid haemorrhage. Acute Medicine, 5:17–19.

6.  Beetham R, et al. (2003) UK National External Quality Assessment for Immunochemistry Working Group. National Guidelines for Analysis of Cerebrospinal Fluid in Suspected Subarachnoid Haemorrhage. Ann Clin Biochem, 40:481–488.


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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