Things I Have Noticed
1) If you present to the ER with chief complaints of headache AND chest pain, then you are most likely suffering from an anxiety disorder. You get bonus points if you are a youngish female. Caveat: this assumes that there is no fever, that the blood pressure is reasonably normal, and that no nitroglycerine has been given. Certainly patients with chest pain who are given nitroglycerine often complain of headache afterwards. And patients with the flu usually hurt all over and it's obvious they are sick. These are not the patients I am considering. Typically, patients with heart attacks don't complain of headaches, and patients with intracerebral catastrophes don't complain of chest pain.
Don't worry, I'm still going to do the CT scans, ECG, cardiac monitoring, and blood tests anyway. I'll probably even admit you. Maybe you've got Lyme Disease. Probably not. Expect a humongous bill when you are discharged with nothing. It costs a lot to make sure your anxiety disorder isn't something worse, and either of your complaints MIGHT be something serious. However, in my experience, the presence of chest pain and headache together is almost diagnostic of anxiety disorder without any tests at all. Unfortunately the lawyers have trained us to order a gazillion tests and overadmit to cover our butts.
Interestingly, studies show that performing MRI scans on patients with chronic headaches is cost effective (due to decreased utilization of subsequent resources), but it is cheaper to empirically treat patients (with proton pump inhibitors) who are diagnosed with noncardiac chest pain rather than working them up further for gastrointestinal causes.
2) You cannot feel when your blood pressure goes up, and it is not causing your headache. In fact, patients with high blood pressure are less likely to get headaches. And if you are worried about a blood pressure of 160/90, then it is likely your anxiety that is driving up your blood pressure. You've probably been taking your BP every 5-10 minutes, and you will bring me several handwritten pages of the strikingly similar BP readings. Which brings me to #3....
3) A patient who has multiple somatic complaints and brings a meticulously detailed litany of their often nonphysiologic symptoms is batshit crazy. There is nothing physically wrong with that person. But she too will undergo the expensive megaworkup. And she will be shocked...SHOCKED!... that all her tests came back normal. "Then why do I feel this way?" she will ask. When I suggest that her symptoms are likely psychosomatic or anxiety-related, she will storm out of the ED in anger, not even willing to consider the possibility that she might have a psychiatric condition. But she does. As soon as she pulls out THE LIST, I know immediately.