Jolt accentuation of a headache

Q: Jolt accentuation of a headache on physical exam raises the possibility of

A) A retinal migraine
B) Meningitis
C) Intra-cranial mass
D) Cervical radiculopathy
E) Subarachnoid hemmorhage 


Answer: B

Although Brudzinski and the Kernig signs have been described as the classic for meningitis, jolt accentuation o a headache may be easier to perform and can be more sensitive 1. It is considered positive if accentuation of a headache occurs by horizontal rotation of the head at a frequency of 2-3/sec. This does not confirm or rule out 2 the diagnosis of meningitis but may make the patient eligible for a lumbar puncture (LP).


References:

1. Uchihara T, Tsukagoshi H. Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. Headache 1991; 31:167. 

2. Tamune H, Takeya H, Suzuki W, et al. Absence of jolt accentuation of headache cannot accurately rule out meningitis in adults. Am J Emerg Med 2013; 31:1601.