In Episode 72 of Med School Question of the Week for USMLE, Hussain Rao, MedSchoolCoach expert tutor, answers this medical school question: A 47-year-old man is brought to the emergency department due to a 1-hour history of sudden onset, severe headache. He states that he was relaxing and watching TV at the onset of symptoms. He states that since the onset of the episode, he has been increasingly nauseous and has vomited several times. He denies any chest pain, palpitations or shortness of breath. He smokes 1 pack of cigarettes per day for the past 25 years. He has a past medical history significant for hypertension and severe migraines that he states typically resolve with administration of sumatriptan. His blood pressure is currently 150/92, but vitals and physical examination are otherwise within normal limits. CT scan of the head is performed and shows no abnormalities. Which of the following is best next step?
- Administer sumatriptan
- Administer 100% oxygen
- Observe in the ED for 4 hours
- Order MRI brain
- Perform lumbar puncture