The patient was a 43-year-old otherwise healthy woman who presented to the Emergency
Department (ED) with complaint of 2 weeks of constant and progressively worsening
right fronto-parietal headache. She was seen in the primary care clinic the day before
presentation and was treated for presumed right maxillary sinusitis with amoxicillin-clavulanate,
ketorolac, and fluticasone. The patient awoke the morning of her ED visit with sudden
onset of the worst headache of her life. She described mild photophobia, nausea and
vomiting for the past 2 days, subjective fevers and chills, and nasal congestion.
She denied any prior history of headaches or migraines, stiff neck, vision changes,
aura, focal weakness, trauma, purulent nasal discharge, intravenous drug use, or history
of malignancy. She had no significant past medical or surgical history, and her only
regular medication was drospirenone and ethinyl estradiol, which she started 2 months
prior for oral contraception. She denied smoking, and drank alcohol socially. There
was no family history of migraines or clotting disorders.
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Article info
Publication history
Published online: February 24, 2009
Accepted:
November 29,
2008
Received in revised form:
November 18,
2008
Received:
July 3,
2008
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
