43: Headache

A 31 year old male presents to the ED with a headache.  He states he rarely gets headaches, but has been having on and off headaches all week.  Tonight, after sexual intercourse, he developed a sudden headache, which is still present.  He denies fever, but has vomited twice.

On exam his vital signs are normal.  You think his neck may be a little stiff, but he can bend his chin to his chest.  The rest of his exam, including a full neurological exam is normal.

CBC and metabolic panel are normal.  The CT scan is read by the radiologist as normal (Image below) so you recommend an LP, but the patient refuses despite all the terrible things you tell him may happen to him.  He says he has been using his iPhone to research headaches and thinks he has a “Post-coital headache”, which he read is not dangerous.

What should you do next?  Is there anyone you should call to help you?

CLICK HERE FOR ANSWER