The headache starts very suddenly, without any warning at all, and feels as if you’ve been hit hard on the back of the head or neck or, alternatively, that there’s been an explosion inside the head. The pain is extreme.

What else could it be?

Four conditions can mimic or be mimicked by a sub-arachnoid haemorrhage:

Meningitis gives the same type of stiff neck, in which the patient is unable to bend his chin to his chest (remember that a true stiff neck is one that cannot be bent forwards). Like a sub-arachnoid haemorrhage, meningitis can also come on quite quickly (but in a matter of hours, not minutes) and soon produces altered consciousness, irritability and drowsiness. Hut patients with meningitis almost always have a temperature, even if it’s only a small one,.

In practice, for the lay person the difference is unimportant. In both cases you need a doctor and you need one now. Don’t wait for the morning; don’t wait even five minutes — it could be the difference between life and death.

A stroke can cause sudden headache, collapse and unconsciousness, within a few minutes. However, paralysis is usually one-sided, with one arm or leg obviously more floppy and paralysed than on the other side.

Headaches coming on during intercourse can mimic a sub-arachnoid haemorrhage, because they come on very quickly, and sometimes almost explosively; and, of course, a sub-arachnoid haemorrhage can be precipitated by the excitement and stress of intercourse. In fact, if a headache of this type and magnitude occurs during intercourse, it may be wise to do a full medical investigation, just to be sure. Once a sub-arachnoid haemorrhage has been eliminated, then it is fair to assume that any further headaches during intercourse are not likely to be sub-arachnoid bleeds.

A very severe tension headache can actually be quite difficult to distinguish from a sub-arachnoid haemorrhage, particularly if it has a sudden onset — such as a sudden tensing of the muscles as a result of a fright; or in a minor injury to the head which reflexively results in all the neck muscles going into spasm (for example, bringing your head up underneath a cupboard, hitting it hard and finding that the resultant reflex pulling of the head downwards by the neck muscles has sent all of them into spasm).

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