Over the handlebars … and into the hospital

A 42 year old man, fit and well, presents to A&E with headache, having fallen off his mountain bike one week earlier.

There was no loss of consciousness and no major injury sustained.

The cycle helmet was not badly damaged.

Key features in the history:

•    headache is in a right hemicranial distribution
•    also affects the right side of the neck
•    constant
•    rated at 8/10 on a pain scale
•    not associated with photophobia, phonophobia or nausea
•    no exacerbating or relieving factors

Also complaining of a droop to the right eye, which his wife has noticed.

Seen in the eye casualty a few days earlier, with a “normal” examination.

1    What are you worried about?
2    Would you admit or discharge?
3    What features might you expect to see on examination?

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