Headache case by case

In this podcast we chat through the case of a 23 year old female patient who walked into the Emergency Department complaining of a severe headache. She had no history of headaches. The pain was 9/10 and she couldn’t localise it. She said she’d had a niggling headache since lunchtime time but it had worsened throughout the day. Described as a throbbing pain, which didn’t radiate down to her neck. At home she’d tried paracetamol which eased it very slightly to an 8/10. Not worsening on bending or coughing. She felt more comfortable with the light off and just wanted to go to sleep. No vomiting.
She stated her vision was fine at the time of review, but for about half an hour before the headache came on she reports not being able to see around the edge of both eyes. She denied any flashing lights or zig-zag lines, no speech disturbance and no weakness of her arms or legs.
She had no past medical history, had a contraceptive coil fitted but on no medications. She lived with her partner, worked in retail, non-smoker, no drugs, occasional alcohol binge.
Nothing to find on examination.
Have a listen to the podcast for the differential diagnoses and to find out what happened.
Music by BenSound.