Sudden onset headache

Q: All of the following presents as a sudden-onset headache except? 

A) Subarachnoid hemorrhage (SAH)
B) Vertebral artery dissection
C) Acute angle-closure glaucoma
D) Pituitary apoplexy
E)  Herpetic meningitis


Answer: E

A sudden onset headache, particularly when it is described as the worst headache of life, and reaches maximal intensity within a few minutes, are all signs of serious central pathologies. The objective of this question is to highlight those headaches which are serious in nature but does not present in a classic 'sudden onset' presentations. These include herpetic or Lyme meningitis, cerebral venous sinus thrombosis, brain tumor, brain abscess, hypertensive encephalopathy, posterior reversible encephalopathy syndrome (PRES), and idiopathic intracranial hypertension.

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Reference:

Tabatabai RR, Swadron SP. Headache in the Emergency Department: Avoiding Misdiagnosis of Dangerous Secondary Causes. Emerg Med Clin North Am 2016; 34:695.