A 36-year-old woman presents to the emergency department two hours after the sudden onset of a severe occipital headache and nau
sea. She has a history of migraine headaches that typically occur in the right frontal area and are associated with an aura. Her temperature is 98.8 degrees Fahrenheit, her neck is supple, and her neurological exam is normal. A non-contrast CT scan of her head is normal. Of the options below, what is the next step in her management? a. Consult a neurologist for evaluation of atypical migraines.
b. Perform a lumbar puncture to rule out the possibility of subarachnoid hemorrhage.
c. Discharge her home with prochlorperazine and close instructions to return if her symptoms worsen.
d. Observe for 6 hours, administer acetaminophen and normal saline, and discharge home if she feels better.
e. Observe for 6 hours and then obtain a repeat CT scan; if
b. Perform a lumbar puncture to rule out the possibility of subarachnoid hemorrhage.
Explanation:
The next step is a lumbar puncture to rule out the possibility of subarachnoid hemorrhage. Once that doctor obtains the cerebrospinal fluid sample, the expert should process it and look for red blood cells to confirm the hemorrhage. Some of the symptoms that the patient presents correlate with subarachnoid hemorrhage (the sudden onset of several headaches, nausea and migraine headaches that typically occur in the right frontal area and are associated with an aura).
