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Headaches

A patient presents with a headache that I “the worst headache ever in my life.”  This patient has no prior history of headaches.

In assessing headaches, several questions are important to consider.  These include whether the patient is having many different types of headaches, the time frame over which the patient has been experiencing them (and if over an extended period of time, what has caused the patient to seek medical help at this time), whether any known causes are relevant (i.e., trauma to the head, stress, eyestrain, etc.), how the patient handles the headache in terms of treatments, and how healthy the patient is between the headaches (Kernick, 2011).

With that said, a patient who does not normally have a headache, and who presents with
a headache characterized as “the worst headache of my life,” may be at serious risk.  This type of headache may indicate a brain aneurysm, and it is a medical emergency (Kernick, 2011).  The patient should immediately be referred to the emergency room of the nearest hospital (or other appropriate medical facility) for immediate evaluation and CT scans to determine if an aneurysm is present (Schonfeld & McMullen, 2008).

Schonfeld & McMullen (2008) point out that this type of “thunderclap” headache occurs typically between 1 week and 2 months prior to the rupture of a saccular (berry-shaped) aneurysm and may be accompanied by nausea, vomiting, loss of consciousness, and stiffness in the neck. The patient may also experience drowsiness, facial pain, problems remembering, seizures, or even temporary blindness. The risk of mortality is high if the aneurysm ruptures.  If the aneurysm ruptures, usually immediate (i.e., within 72 hrs) surgery is required, though not all aneurysms are operable (Finitsis et al., 2010).



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