Meningitis is an infection of the coverings of the brain, the meninges, and the fluid surrounding the brain and spinal cord, the cerebrospinal fluid. It can be caused by viruses or by bacteria. While the bacterial form is much more dangerous and has the potential to lead to severe neurological injury and death if not treated promptly, both have similar presentations. Both cause headache as one of the hallmark symptoms.
Because of the infection and severe inflammation of the coverings of brain, any movement of the head and neck can be very painful. Generally it is a severe headache (with or without a back ache as well) that progresses rapidly and is accompanied by a high fever. The patient generally has a very stiff, painful neck as well, called nuchal rigidity. It is so painful that they keep their neck very rigid to prevent any movement, even if they are lethargic or unconscious. Photophobia, as with migraines and subarachnoid hemorrhage, and seizures can occur as well. In the case of bacterial meningitis, these symptoms can quickly escalate to a progressively deteriorating level of consciousness, coma and eventually death if not treated quickly.
The combination of high fever, headache, stiff neck and/or lethargy should be considered concerning for meningitis until proven otherwise. Untreated bacterial meningitis can progress quickly and can be life-threatening. Thankfully it is relatively rare.
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