ABSTRACT
A 68-year-old man presented to the emergency department complaining of a 2-day history of gradual-onset generalised headache, which he had never had before. It was described as a ‘strong pressure’ over the entire head and he said it felt ‘as though my head will explode’. The pain initially developed following a long spell outdoors in the cold weather. There were no exacerbating or relieving features. The headache was associated with left-sided facial numbness and tingling around the mandible. He complained that the left side of the face felt ‘congested’ and was tender to touch. He denied scalp tenderness but did have some jaw pain when he chewed food. His past medical history included lung adenocarcinoma, which was diagnosed 6 years ago and treated (with curative intent) with a lobectomy. His history also included rheumatoid arthritis, which was diagnosed 30 years ago and was previously managed with methotrexate. This had been well controlled until recent weeks when he had noted morning stiffness and widespread joint pain. He used a long-acting tiotropium inhaler and took 10 mg lercanidipine once daily. He was a retired welder and lived with his female partner. He stopped smoking 6 years ago and had an 80 pack year history. He drank 8 units of alcohol per week.
