Question

A 39-year-old woman presents with sudden-onset severe worst-ever headache and vomiting. She has photophobia and neck stiffness. CT head without contrast performed within 2 hours of onset is normal. What is the most appropriate next step?

Accepted Answer

Perform a lumbar puncture to look for xanthochromia

Answer

Reassure; CT has ruled out subarachnoid haemorrhage

Answer

Order MRI brain with gadolinium

Answer

Schedule outpatient neurology review

Answer

Start migraine prophylaxis

Practice question

A 39-year-old woman presents with sudden-onset severe worst-ever headache and vomiting. She has photophobia and neck stiffness. CT head without contrast performed within 2 hours of onset is normal. What is the most appropriate next step?