When the 'worst headache ever' means so much more
A 36-year-old female called into United Concierge Medicine, concerned about a headache that suddenly started the prior day and progressively worsened overnight. She had two episodes of vomiting, developed light sensitivity and extreme fatigue, and measured a low-grade fever of 100 prior to her call.
"This is the worst headache I have ever had,” the patient told our UCM provider. She further explained that she never gets headaches, and Motrin and Tylenol were not helping with her pain. The UCM provider quickly initiated a face-to-face video chat, noting that the patient appeared very fatigued, pale, and sweaty. In talking with the patient, the provider discovered that the patient did not have a history of migraines or aneurysms in her family, she was not on any medications, and she was otherwise healthy.
The patient’s husband was witnessing the call, and the UCM provider asked him to help him with an exam to assess neck stiffness/rigidity. With the patient lying flat on her back, her husband was instructed to gently hold her head and flex her neck. It was at this point that the UCM provider noted a concerning sign of nuchal rigidity. The patient could not flex her neck much at all before she felt a sharp pain shoot down her spine.
The UCM provider calls ahead to the emergency room to ensure a quicker response
The UCM provider was concerned about possible meningitis in the patient, recommended the patient’s husband drive the patient to the local Emergency Department for further evaluation. To ensure a quicker response once the patient and her husband arrived at the ER, the UCM provider called ahead to the ER attending doctor on staff and explained his concerns. This allowed the patient to be recognized upon arrival to triage and she was escorted back to start her emergency evaluation.
During a follow-up phone call by the provider to the patient the next day, the patient described that she had a lumbar puncture procedure and she was admitted and treated for meningitis. Meningitis is a potentially life-threatening inflammation of the membranes surrounding the brain and spinal cord, caused in some cases, by viruses, bacteria, parasites, or fungus. Symptoms include:
- Sudden high fever
- Stiff neck
- Severe headache that seems different than normal
- Headache with nausea or vomiting
- Confusion or difficulty concentrating
- Sleepiness or difficulty waking
- Sensitivity to light
- No appetite or thirst
- Skin rash (sometimes, such as in meningococcal meningitis)
What you should know
At United Concierge Medicine, our goal as virtual ER providers is to ensure our patients receive right care, at the right place, at the right time — and occasionally, that means insisting they immediately go to the hospital's emergency room. Our providers are trained to recognize emergency situations, even when the patient may not realize how critical the situation actually is; and, in this patient's case, her presenting symptoms concerned our provider enough to send her to the ER.