A 32 yo woman suffers an episode of severe occipital headache with vomiting and loss of
consciousness. She is brought to the hospital where she is found to be conscious and completely
alert. Exam: normal pulse & BP. No abnormal neurological signs. What is the next step in
management?
a. Admission for observation
b. CT brain
c. MRI head
d. Reassurance and discharge
e. XR skull
Ans. The key is B. CT brain. [basilar migraine can cause severe headache and LOC. But there occurs no
neurological deficit and on recovering from unconsciousness becomes completely alert. But to diagnose
basilar migraine there should at least history of two migraine attacks with aura. As here diagnostic
criteria of basilar migraine is not fulfilled we can not discharge the patient without neuroimaging like CT
or MRI].