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71yrs old male patient with history of coronary artery stenting in 2024 was having symptoms of headache since 2 days mild eye pain no other upper or lower limb weakness on regular treatment..last mri done in Feb 2026 was normal On tab rosumac gold od tab concor od tab flavedon mr bd Bp 160/80 Last blood tests and vision checked 2yrs ago What could it be and what investigation should be done now

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giant cell arteritis AND diagnosis

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NICE headache red flags giant cell arteritis eye pain urgent assessment acute angle closure glaucoma

A new headache with eye pain in a 71-year-old needs an in-person assessment today, even without limb weakness and despite a normal MRI in February. A normal MRI months ago does not exclude a new eye, vascular, or inflammatory problem now.

Important possibilities to rule out first

  1. Giant cell arteritis (temporal arteritis)
    This can occur after age 50 and may cause new headache, scalp tenderness, jaw pain when chewing, fever, fatigue, or visual symptoms. It can threaten sight and needs same-day assessment.
  2. Acute eye-pressure problem, especially angle-closure glaucoma
    More likely if there is a red eye, blurred or misty vision, halos around lights, nausea/vomiting, or marked eye pain. This is an eye emergency.
  3. Blood-pressure elevation or a primary headache
    A BP of 160/80 is high and needs treatment review, but by itself is less commonly the direct cause of headache unless much higher or accompanied by acute organ damage. Do not assume the headache is only due to BP.
  4. Less commonly: a new brain/vascular problem, infection, sinus/dental cause, or medication-related issue. His age and vascular history mean these should be assessed rather than self-treated.

Go to emergency care now if any of these are present

  • Any reduction, blurring, double vision, visual field loss, halos, or red eye
  • Sudden severe "worst-ever" headache or headache peaking within minutes
  • Confusion, fainting, drowsiness, vomiting, fever, stiff neck, seizure
  • Facial droop, speech difficulty, imbalance, numbness or weakness
  • Jaw pain on chewing, scalp tenderness, or temple tenderness
  • Chest pain, breathlessness, or BP repeatedly 180/120 or higher
NICE recommends urgent evaluation of headache with features suggestive of giant cell arteritis or acute narrow-angle glaucoma. NICE headache guidance

What should be checked today

At a hospital emergency department, urgent clinic, or by a physician who can arrange same-day referral:
Clinical examination
  • Repeat BP properly, in both arms if appropriate
  • Full neurological examination
  • Examination of temporal arteries and scalp tenderness
  • Visual acuity, pupils, eye movements, visual fields, and fundus examination
Urgent eye assessment
  • Ophthalmologist/eye emergency assessment if eye pain persists or there is any visual symptom
  • Slit-lamp examination
  • Intraocular-pressure measurement
  • Dilated retinal/optic-nerve examination
Blood tests
  • CBC/FBC with platelet count
  • ESR and CRP urgently to assess for giant cell arteritis
  • Blood glucose/HbA1c
  • Kidney function, electrolytes, liver profile
  • Lipid profile
  • Thyroid testing can be considered depending on examination/history
Imaging
  • Urgent non-contrast CT brain if red flags, abnormal examination, sudden severe headache, vomiting, altered consciousness, or concern for bleeding/stroke.
  • MRI brain or vascular imaging is selected by the treating doctor if examination or CT suggests it. It is not necessarily the first test in every uncomplicated 2-day headache.
  • If giant cell arteritis is suspected: temporal-artery ultrasound and/or temporal-artery biopsy, directed by the specialist. Treatment should not be delayed if sight is at risk.

Medication point

Do not stop Rosumac Gold or any antiplatelet medication on your own, particularly after coronary stenting. The exact components should be verified from the strip, but these regimens often include antiplatelet medicine and a statin. Bring all medication strips and the stent/cardiology records to the assessment. BP medication may need adjustment, but only after a clinician reviews pulse, ECG, kidney function, and the current headache/eye findings.
The immediate priority is ruling out giant cell arteritis and an eye emergency, not simply repeating an old MRI. A recent systematic review also highlights that no single clinical prediction model reliably substitutes for proper evaluation of suspected giant cell arteritis (PMID: 40592550).
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