Question

A 40-year-old woman with a history of migraines presents with a sudden change in her usual headache: a new severe occipital headache on exertion with neck pain. She has no neurological deficits, but this headache is unlike her prior episodes. What is the most appropriate next step?

Accepted Answer

Order urgent CT angiography or MRI to exclude cervical artery dissection or subarachnoid haemorrhage

Answer

Treat as usual migraine with triptans

Answer

Reassure as headaches are common

Answer

Start prophylactic beta blocker and review in 3 months

Answer

Advise over-the-counter analgesics only

Practice question

A 40-year-old woman with a history of migraines presents with a sudden change in her usual headache: a new severe occipital headache on exertion with neck pain. She has no neurological deficits, but this headache is unlike her prior episodes. What is the most appropriate next step?