Severe Headache with Neck Pain

A 14 year old patient was brought to the emergency room by his parents after 6 days of fever with severe headache and photophobia.
He was otherwise in good health, fully vaccinated including pneumococcal and meningococcus C vaccinations. In his medical history the only relevant problem is a facial trauma 6 months before, consisting of skin lacerations which were sutured overlying a minor left maxillary fracture which needed no surgical repair.

The clinical exam showed an ill-looking patient, febrile, pale and visibly uncomfortable. Vital signs showed mild tachycardia with blood pressure of 102/65mmHg.
His neurological exam does not reveal any focal deficit but was notable for severe frontal head and neck pain. The neck pain resulted in neck stiffness in all directions. Palpation of the cervical spine was excruciatingly painful.

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