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Sudden headache

Causes

  1. Subarachnoid haemorrhage
  2. Migraine or migraine variant: coital cephalgia, exercise headache
  3. Viral meningitis
  4. Raised intracranial pressure (rapid decompensation)

Demographics

Subarachnoid haemorrhage 1 in 8. 5–10 per 100,000 per year.
aet. <40 M>F
aet. >40 M<F

Clinical features

Subarachnoid haemorrhage suggested by:
  1. collapse
  2. vomiting
  3. photophobia
  4. meningism

Management

Emergency CT (false negative in 15%)
LP shows xanthochromia
Resuscitate
Nimodipine 60 mg qqh