More younger people are affected by subarachnoid haemorrhage (SAH) than by any other form of stroke, and fatality rates are high (van Gijn et al 2007). Classic signs and symptoms include sudden onset of 'thunderclap' headache but patients can present with atypical symptoms such as neck stiffness. For patients who survive SAH, the psychosocial consequences can be devastating and can affect their families or carers. This article describes the management of one patient who attended an emergency department with atypical symptoms of SAH, and discusses the incidence of, investigations into, and treatment for SAH.