Associated phenomena

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Nausea and vomiting typically accompany migraine: whereas raised intracranial pressure headache may be associated with vomiting, but often without nausea. Tension headache is not usually accompanied by Liny of these symptoms. Migraine is often accompanied by intolerance to lighl (photophobia) or noise (phonophobia), irritability, food cravings and hunger, In 15-20% of patients visual disturbances (teichopsia and fortification spectra) and/or peripheral and circumoral paraesthesiae occur, usually before the headache phase (migrainous aura). Patients with cluster headaches may expcricncc watering of the eye or

CASE HISTORY

A 22-year-old undergraduate developed severe headache while attending a hockey team practice. She vomited and felt 'dazed'. She was driven to her flat by a friend and went to bed with p persistent headache. Her flat mate who was a student nurse returned hdtyie. and detected neck stiffness and took the patient to hospital. The patienfwas apyrexial and there were no focal neurological signs, but she had severe meningeal irritation. An urgent CT scan was arranged and confirmed the diagnosis of subarachnoid haemorrhage (Fig. 6.1).

Learning points

• Apparently healthy individuals may have life-threatening conditions.

• Because ot the risk of potentially lethal rebleeding, the early diagnosis and treatment ol subarachnoid haemorrhage is particularly Important in patients who are conscious and neurological y intact.

Subarachnoid Hemorrhage Scan
Fig. 6.1 CT scan of the brain showing subarachnoid blood in the suprasellar cistern and both sylvian fissures (arrowheads).

nose or even ptosis of an eyelid during attacks, and occasionally the ptosis may persist afterwards,

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