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A 20-year-old man presented with acute headaches to a primary care hospital. The patient was treated by a general practitioner for bilateral purulent tonsillitis with corticosteroid (1 mg/kg of prednisone) and antibiotics (3 g/day of amoxicillin/clavulanic acid) for 5 days. He reported spontaneous thunderclap bilateral headaches with a 6/10 on a visual analogue pain scale.

photo credit: bikeriderlondon/Shutterstock




Please use the discussion feature below to ask the authors your questions and provide further feedback on others’ questions. All questions and replies are moderated.


  1. Eric Holbrook

    I would use caution in performing a lumbar puncture in any patient with a pneumocephalus that may be under tension to avoid the risk of brain herniation.

  2. Dr Hung


  3. Marco Cesar Jorge dos Santos

    Cerebral venous sinus thrombosis

    1. Roberto

      I agree


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