I have a terrible time when I see someone with the triad of fever, headache, and neck stiffness. The diagnosis that I don't want to miss of course is meningitis. Unfortunately there is so much that can give these symtpoms that is not meningitis that it would be poor practice to do a spinal tap on all of these folks who probably just have the influenza, a garden variety cold, or strep throat (I have seen one case of meningitis from Group A strep and perhaps this has still scarred me).
Yesterday I had a guy in his mid twenties well known to me who complained of shaking chills at home (no fever in the office), a headache, and neck pain. He had the sore throat, cough, and a few other fairly nonspecific symptoms. He looked pretty non toxic except when I had him flex his neck as part of his exam to assess for meningitis. He said it hurt and it hurt a lot. He moaned as I had him repeat the maneuver.
Like I said, I know this guy well. I know he's, well, not the most tolerant of pain or of being sick. While I don't recommend the approach that I then took, I sighed and said, "OK, is this neck pain so severe that we should stick a needle in your back and do a spinal tap to rule out meningitis?"
His eyes opened wide and he quickly lifted his head up, "No, it doesn't hurt that bad. I think I'll be fine."