Headache, Confusion & Delirium [Case #2]

“A 20 year old lady attends the ED with a history of daily headache, it is in the front of her head and worse when she lies down. She feels sick with it but has not vomited. Paracetamol and ibuprofen have had no effect on the headache. She has no significant PMH, but is on the OCP.”

Examination reveals a slightly overweight woman with normal observations. Your neurological examination is essentially normal, except you think you may have seen papiloedema on fundoscopy. After 60 mg of dihydrocodine she feels her headache is slightly better.

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

1. What is your differential diagnosis?

2. How would you investigate this lady in the ED?

3. What are the symptoms of raised ICP?

4. What are the signs of raised ICP?

5. Would this lady be suitable for discharge? 

6. She picks up that you are concerned and asks if you think she has cancer, what would you tell her?