Sounds like a vascular anomaly that ruptured...cerebral
aneurysms and arteriovenous malformations in the brain are rare
abnormalities of blood vessels in the brain. When they rupture, the
mortality is very high. Thankfully, they are rare but occasionally
seen associated with conditions like polycystic kidney disease and
Marfan's syndrome. Quite a number of victims tend to be very young
though. The typical story is a young person who wakes up with a
sudden terrible headache and lose consciousness soon after. The
prognosis is very poor once the vessel has ruptured.
The difficulty with diagnosis is because these conditions tend to
be silent until they rupture. The only way to diagnose them is a
brain scan and angiography may be required in some cases in
addition.
Some cases give a 'warning bleed' before full rupture and the only
symptom is headache, especially associated with neck stiffness.
However, everyone gets headache from time to time and it is not
logical to scan everyone with a headache. Not only is the cost high
but there are risks with the procedure as well. Rarely, some
patients die from an allergic reaction to the dye used for the
scan. So doctors must not bow to pressure from the ignorant public
and simply scan everyone with a headache. You will kill more people
that way than save the very few with this rare condition.
The management is correct in this case. Give painkillers and see if
the headache goes away. If the pain is persistent as it appears to
be in this case, make an appointment to see a neurologist. There is
nothing in the story that indicates a dangerous vascular
malformation, which is, after all, rare. Unfortunately the young
man happens to be one of the very few with this condition. Had he
presented with an epileptic fit, he would have had the scan
immediately but no, he only had the common headache.
A non-urgent appointment to see a neurologist for persistent
headache in two weeks is very reasonable. In the UK, you would be
lucky to see one in 3 months' time.
