A 45-year-old female artist is brought to the ED from her basement art studio with a chief complaint of dull severe headache with gradual onset. She currently rates her headache as 6 out of 10 which has greatly improved from 9 out of 10 an hour ago when the headache started. She has not received any treatment. She is currently alert and oriented with no focal neurologic findings, but she mentions mild disorientation at the peak of her symptoms. She has had similar episodes in the past two months starting last November for which she has sought treatment multiple times. This time her symptoms were exacerbated by disorientation and severe nausea. The episodes seem to happen only when she is focused on her work in her studio. What is the best next step for diagnosis of the most probable critical diagnosis in this patient?

About the Author: Anton Helman

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.