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Have A&E under reacted?(35 Posts)
Adult ds has had a bad headache for a week now. Out of ten he rates it as between 6 and 11 in so far as it never goes away and is anything between bad and awful. Been taking maximum dose paracetamol and ibuprofen now since last Thursday.
Finally saw GP yesterday morning as had had vomiting and photophobia and pain when moving for two days. GP examined him temp and blood pressure normal, some stiffness in neck and blurred optic discs.
Sent him to A&E to rule out meningitis and "anything nasty" Ds had normal ECG and bloods were clear. Was told scanner was fully booked but they would write to GP about needing a scan in a couple of days as optic discs malaligned but described it as a severe migraine.
Ds is still no better, has spent the day laid in the dark or sleeping. He will return to GP tomorrow at my insistence.
Could this be a severe migraine? I'm trying not to panic but it's difficult.
Please take him straight back to A&E. You can't be too careful.
My sister had a bad headache, didn't want to make a fuss, but mum had a bad feeling and insisted on travelling several hours to see her. GP said she was fine, first doctor in A&E said she was fine, mum was pushy and insisted on a second opinion. They kept her overnight to "keep an eye" and within a few hours she was in a coma. She had bacterial meningitis. Miraculously she has made a full recovery with no lasting problems, but every second counted.
I don't want to worry you - but it's worth being pushy for your own peace of mind. I hope he's feeling better soon!!!
Obviously not a medical professional in any way - that's just what I would do if I were you.
Unfortunately migraines can be severe and can last a long time. Obviously if you are concerned its fine to go back to a&e but it may well be a migraine. I think sometimes they are seen as a bit of a non event but in actuality can be severe, come with many other symptoms and be prolonged.
So are a and e arranging a scan or are they passing back to Gp?
If he can tolerate it worth seeing if he can get to optician for photos of backs of eyes - they are fantastic at looking at optic discs and far superior to any dr. Drs have the most basic equipment. If he has swollen discs he needs an urgent scan, no question. It would give you and your Gp ammunition to get things moving.
If you’re seriously worried keep pushing, either back to a and e or your Gp. Trust your gut op.
This could well be a migraine which can present like this. Most severe migraineurs find themselves In hospital the first time (myself included) as the symptoms can be so severe and scary, it’s certainly not just a headache. If you are not sure though don’t feel silly taking him back. Better safe than sorry.
Is this his first ever severe headache?
It could well be a migraine but more than meningitis he should have subarachnoid haemorrhage considered. Which I'm sure they did do in a&e but have low threshold for going back if worsening or changing
No he does get migraines but they are generally short lived, generally a spell of vomiting and a sleep and they have gone. He never needs to take more than two lots of painkillers and they never continue the following day and he doesn't have photophobia or pain on moving when he has them. So yes he has severe headache then but not as long lived and not as painful as it is currently when at its worst.
I would take him back to A&E. A more severe headache than normal with different symptoms associated with it would make me think carefully when I was an A&E doctor.
Does he remember how it started - did it come on suddenly? I see heyd has suggested a subarachnoid hemorrhage. My DH had this, but there was a very definite starting point - he had a 'funny turn' a bit like a seizure where he couldn't speak properly, and the headache hit straight after that.
A&E don't do fishing expeditions. Their tests aren't indicating anything they can treat (sorry).
Agree about seeing an optician to rule out optic swelling.
I'll tell him to try the opticians tomorrow that's a good idea. He was at work when it started, thought it was the start of a migraine, left work early went to bed expecting that he'd sleep it off and it's not gone since then. Hopefully I'm worrying for nothing.
Won’t give you another horror story, but back to A&E, go with him if you can, he’ll be in no state to advocate for himself.
If he does have yo go back, would you be able to go with him? It's worth asking for clarity about exactly what they have considered and ruled out. Might give you some peace of mind.
I agree with lljk, A&E have already seen him. Why would they do anything differently because you take him back?
Because doctors never miss anything so they?. He isn't getting better. GP says he needs a scan. Other doctors will be on. Go with your instincts.
We did that once.
DH saw GP who said DH had asthma.
I didn't think Asthma involved coughing so much that speech became impossible (for days on end).
Went to the walk-in clinic. Plan to see "another doctor."
Who should be on duty... but DH's regular GP!
Who at least let a nurse practitioner examine DH.
She diagnosed chest infection.
GP said the symptoms hadn't been there the day he examined DH.
But they didn't do a different test. I don't think GP made a mistake either. There were actual different symptoms presenting. So I guess that's what OP would have to hope for. I've currently got a cat who I suspect has hyperthyroidism but that diagnosis was ruled out last year, I'm wondering when to take cat for another check. Severe puking all over cat carrier last time that's how much cat hates car travel.
Go back if you are concerned. This is not normal for him. If the GP saw blurred optic discs I wouldn't be happy until the patient has had a CT scan. This can happen more quickly via A&E than through a GP. It might just be a migraine but if it isn't worth taking the risk. The value of going back is that hopefully you get a second opinion but even if it is the same doctor your son now is a patient a few hours further along who hasn't improved so their opinion might change. Good luck.
Did they do a lumbar puncture OP. I’d be wanted to rule out benign intercranial hypertension with his history and with the blurred discs. They could be doing that whilst you wait for imaging.
Hopefully, he’s being checked out at the moment.
@underneaththeash doing an LP in someone with swollen discs and no imaging is contraindicated. (From someone who does a lot of LPs).
Grey - thanks for that I wasn’t aware. Why is that?
underneath in case the cause of raised ICP isn’t benign
The fluid that’s removed during an LP is in continuity with the fluid surrounding the brain. Essentially, if the swollen discs are caused by a mass inside the skull and you remove a load of fluid from the low back the loss of volume in the back could cause the cranial contents to be sucked down. This can irreversibly squash the brain stem & the worst case scenario would be the person dying as the LP is performed. While most neurosurgeons/neuroradiologists would probably say the chance if this happening in real life is rare, it’s not really an acceptable risk most of the time.
Are you within travelling range of a specialist eye hospital? They do Eye A&E/walk-ins. From personal experience, the one at the Manchester Royal Eye Hospital diagnosed the problem I had that the local A&E failed to find. They have better equipment than either the local A&E or a high street optician. Alternatively, is there a possibility of a very urgent referral from the GP to your nearest Eye department?
Brain hemorrhage survivor here! Please demand a ct or mri scan just to rule out a haemorrhage or something similar. Mine started with an extreme headache that wouldn't go with paracetamol or any other painkillers. Few days later i was taken to hospital lost my speech and ability to pick things up in right hand, similar to a stroke. Please dont leave this. Better to be scanned and hopefully find nothing than leaving it too late.