Blog Viewer

A 38-year-old man presents with a severe headache. Why?

NursingSKL clinical tip

By NursingSKL
March 13, 2023
iStock/ajr_images; NursingSKL

When approaching a patient with a headache, as a nurse, there are two critical questions that you must ask your patient.

  1. First, you have to quantify the severity of the headache. Headaches that are severe may be associated with very serious pathology. For instance, a patient presenting with the “most severe headache of their life” may have an intracranial hemorrhage (often a subarachnoid hemorrhage, which may be related to a ruptured aneurysm).
  2. Second, is the headache associated with any other symptoms? Specifically, you are searching for symptoms that are suggestive of neurologic dysfunction. Is it associated with paresthesias, weakness, imbalance, neck rigidity? How about double vision (may represent a cranial nerve 3rd, 4th or 6th nerve palsy)? How about a dilated pupil (may represent compression of the 3rd cranial nerve?)

In this particular situation, the patient had a two-month history of a headache. They did not complain of any pins or needles or of any weakness. Their neurologic examination was unremarkable. A dilated eye examination demonstrated bilateral swelling of the optic discs. An MRI demonstrated a brain tumor (a glioblastoma).

Clinical tip: In any patient with the “worst headache of their life,” or a headache associated with a dilated pupil, you must rule out intracranial pathology.


In this video, you will learn the three key questions to ask a patient with a headache.

This clinical tip was provided by NursingSKL, a collaborative initiative between leading doctors and nurses to improve nurses’ clinical skills. Go to to find out more, meet the faculty, and try our free Practicum on Diabetes Care.
All CNA members get a 25% member discount on NursingSKL’s practicums. Sign in to your CNA account and access NursingSKL through the My Benefits tab.