Author: Helen Blackhurst / Editor: Jason M Kendall / Reviewer: Chris Wearmouth / Codes: NeuP2, PC1, SLO1Published: 16/12/2020

A 42-year-old man presents to the Emergency Department at 4am with a severe headache. He is pacing up and down and says that he has been woken up by a similar headache every night for the last 4 nights. Paracetamol has had no effect. The headache is right sided and frontal. There is no nausea or visual disturbance. He is complaining of sinus congestion but no nasal discharge. On examination his right eye is watering slightly. There is no focal neurology; blood pressure is 165/103 with no papilloedema.

There is no history of migraine.

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