TEST QUESTION: Severe Headache


CORRECT ANSWER: B) Call the on call for stat (immediate) head CT

  • The key words here are “sudden severe headache”. This equals a red flag. Generally a MRI is done after CT head is performed –specifically if no acute finds on the CT. See differential list below for potential causes of headaches.
  • The blood pressure is in 150’s– which wouldn’t likely be the cause of a severe headache. Although it is important to note, that the higher the blood pressure gets-symptoms of headache, blurred vision, and nausea can develop. It is important to note that pain may be what is actually causing the blood pressure to increase. Hydralazine is sometimes a PRN (as needed) medication on the chart. It is usually under set parameters to give if SBP >160, >170, >180, >190, etc…
  • Although administering acetomenophen might be something to do at some point for the pain-it’s important to realize the significance and urgency of a sudden severe headache. Think about what needs to come first in this situation? What are the potential causes?
  • See the list of differential diagnosis below-subdural hematomas, stroke, some things to think about


Acute angle-closure glaucoma

Acute mountain syndrome/hypoxia

Alcohol withdrawal

Caffeine withdrawal

Carbon monoxide poisoning

Cervical disc disease-bulging discs

Concussion/head trauma



Elevated blood pressure

Increased intracranial pressure


Medication overuse

Medication withdrawal


Migraines-cluster, tension

Neck tension


Subarachnoid hemorrhage

Subdural hematoma


Temporal arteritis



Trigeminal neuralgia


These are just some of the potential causes

Β  This is not an all-inclusive list…..


  1. Epocrates- (paid version) Differential Dx list headaches

DISCLAIMER:Β The information posted is not intended to be medical advice. Check with your primary care provider regarding questions about your health. This post and all other posts are for educational purposes only. This information is intended for medical professionals & students. This is not intended to guide in medical decisions or treatment in any way. As always, medical professionals should call the on call provider if any clarifications are needed. State and hospital protocols should always be followed accordingly.Β Med Made Ez (MME) disclaims any liability for the decisions you make based on this information.

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