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Subarachnoid haemorrhage — DIPIMC MCQ

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HardMedical EmergenciesSubarachnoid haemorrhageDIPIMCDipIMC

A 48-year-old describes a sudden, severe occipital headache that reached maximum intensity within seconds while she was lifting a heavy box an hour ago. She vomited once and is now photophobic with neck stiffness, although her GCS is 15. What is the most appropriate management?

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Correct answer: C — Suspect subarachnoid haemorrhage; transfer urgently

A thunderclap headache reaching peak intensity within seconds, with vomiting and meningism, is a subarachnoid haemorrhage until proven otherwise and warrants urgent transfer for imaging and assessment. Attributing it to migraine or tension headache risks missing a catastrophic bleed. A triptan is inappropriate and unsafe where haemorrhage is possible. Pearl: the speed of onset to maximum intensity, rather than the absolute severity, is the key discriminating feature.

Reference: JRCALC Clinical Guidelines