What to do for a 45-year-old woman presenting with headache, body aches, low appetite, cold symptoms, and weakness?

Initial Assessment and Triage

This patient requires urgent evaluation to rule out serious secondary causes before attributing symptoms to a viral illness, given the constellation of systemic symptoms including headache, body aches, weakness, and cold symptoms. 1

Red Flag Assessment

The immediate priority is determining whether this presentation represents a benign viral syndrome versus a life-threatening condition requiring emergency intervention:

• Headache characteristics must be clarified: Sudden onset ("thunderclap"), worst headache of life, or headache with fever and neck stiffness warrant immediate emergency department evaluation for subarachnoid hemorrhage or meningitis 2, 3
• Neurological examination is essential: Any altered mental status, focal neurological deficits, seizures, or cranial nerve abnormalities require urgent neuroimaging and possible lumbar puncture 2
• Fever with headache and weakness: This combination necessitates ruling out meningitis or encephalitis through physical examination for meningismus, photophobia, and altered consciousness 2

Diagnostic Workup

If red flags are absent and symptoms suggest a viral illness, the following evaluation should be performed:

• Vital signs assessment: Temperature, blood pressure, heart rate, respiratory rate, and oxygen saturation to identify hemodynamic instability or hypoxia 2
• Physical examination focusing on: Neck stiffness, neurological deficits, respiratory symptoms (cough, dyspnea), and signs of dehydration 2
• Laboratory testing if indicated: Complete blood count, metabolic panel, and inflammatory markers (ESR, CRP) if systemic infection is suspected 2
• Neuroimaging (MRI brain with contrast): Required if headache has atypical features, worsens with exertion, or is accompanied by unexplained neurologic findings 1

Management Strategy

For Presumed Viral Syndrome (After Excluding Red Flags)

Symptomatic treatment should focus on NSAIDs for headache and body aches, with specific attention to hydration status:

• NSAIDs as first-line therapy: Ibuprofen or naproxen for headache and body aches, avoiding opioids due to risk of dependency and rebound headaches 1, 3
• Hydration: IV crystalloid solutions only if clinical dehydration is confirmed; routine IV hydration is not indicated 3
• Supportive care: Rest, adequate fluid intake, and monitoring for symptom progression 2

Warning Signs Requiring Immediate Re-evaluation

Patients should return immediately or call emergency services if any of the following develop:

• Headache suddenly worsens or becomes "worst ever experienced" 2
• New confusion, altered mental status, or difficulty staying awake 2
• Fever with severe headache and neck stiffness 2
• New neurological symptoms (weakness, numbness, vision changes, difficulty speaking) 2
• Persistent vomiting or inability to maintain hydration 2
• Respiratory distress or oxygen saturation below 90% 2

Follow-Up and Monitoring

Close follow-up within 24-48 hours is essential to reassess symptom progression:

• Symptom diary: Document headache frequency, severity, associated symptoms, and medication response 1, 4
• Reassessment criteria: If symptoms worsen despite treatment, persist beyond 7-10 days, or new symptoms develop, further evaluation including possible neuroimaging is warranted 1, 4
• Specialist referral: Consider neurology referral if headache pattern changes, becomes chronic, or shows poor response to initial management 4, 3

Common Pitfalls to Avoid

• Do not assume all headaches with systemic symptoms are benign viral illnesses: Always perform thorough neurological examination to exclude secondary causes 2, 3
• Avoid prescribing opioids: They are ineffective for primary headaches and carry significant risks of dependency and medication overuse headache 1, 3
• Do not delay emergency evaluation: Patients with severe headache, fever, and altered mental status require immediate assessment for meningitis or encephalitis 2
• Recognize that typical viral symptoms can mask serious conditions: Elderly patients and immunocompromised individuals may present atypically 2