A 22-year-old female presents with a severe headache associated with neck stiffness, fever, and photophobia. She has a history of migraines. What could be the potential diagnoses, and what are the next steps?
Even though this patient has a history of migraines, the addition of neck stiffness and fever raises concern for conditions like meningitis. Other differential diagnoses could include a severe form of migraine or a subarachnoid hemorrhage. An urgent lumbar puncture should be considered to rule out meningitis, after a CT scan to rule out any space-occupying lesion or hemorrhage.