Abstract
This case report presented a rare cause of severe headache in a patient who developed episodes of acute severe headache for the first time. The earliest accurate provisional diagnosis is crucial for a new onset severe headache in adult. A good history taking and high index of suspicious are remained the most important clinical component in managing severe first time headache in adult. The differential diagnosis of subarachnoid hemorrhage, space-occupying lesion with increased intracranial pressure, acute intoxication, meningo-encephalitis and others must be ruled out as these conditions are benefited in early management. In this patient, progressive development of headache is masked by severe intense headache, which later will be described as acute headache. The causes of newly onset severe intense headache will be discussed in the discussion.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.399-401
Highlights
Headache is defined as diffuse pain in various parts of the head
The first time and the worst headache the patient ever had warrant an urgent investigation and management. This case report will highlight the relevant history, clinical finding and investigation in order to come to a diagnosis and to rule out life threatening causes of acute, new onset severe headache in an adult
Case report We report a 45-year old Malay lady with acute severe headache for the first time
Summary
Headache is defined as diffuse pain in various parts of the head. Most of the time, headache is poorly localised as the pain is undifferentiated and not correlates with the nerve distribution. The first time and the worst headache the patient ever had warrant an urgent investigation and management This case report will highlight the relevant history, clinical finding and investigation in order to come to a diagnosis and to rule out life threatening causes of acute, new onset severe headache in an adult. Physical examination revealed the blood pressure was high, 170/117 mmHg but gradually return to normal within 3 hours with rest and general pain management Her pulse rate was 100 per minute and afebrile. Further history revealed that the patient has been having chronic pain secondary to failed back surgery of prolapsed intervertebral disc for the past 15 years She was on multiple type of analgesic and has been taking celecoxib frequently especially during flare up episodes. After a week of stopping celecoxib, another episode of headache occurred but it was much less in severity
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