Suggest treatment for severe headache in a hypertensive person
I believe he does need to go to ER
I read your question carefully and I understand your concern.
Given your description of very intense pain, of an abrupt onset, with no prior occurrences I would say that attention is needed and a visit to ER is advisable.
Hopefully it will turn out in the end to be just a migraine with visual aura, but given that 54 is an uncommon age to have ones first migraine attack and given the fact the pain was so abrupt I believe he should be evaluated for the possibility of a subarachnoid hemorrhage. For that apart from the careful history taking checking for signs of meningeal irritation is necessary like neck rigidity. However when description of very sudden, very intense pain, of an intensity never experienced before it is advised even when there are no signs to have a CT scan.
Let me know if I can further assist you.
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