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Systemic Symptoms

or Illness

  • Fever, weight loss, persistent or progressive vomiting, stiff neck,
  • Pregnancy, cancer, immunocompromised state, anticoagulated state

Headache

Mneumonic

Neurologic Signs

& Symptoms

  • Altered mental status
  • Weakness
  • Focal neurologic symptoms
  • Seizures
  • Papilledema

S - systemic signs

N - neurologic signs

O - onset sudden

O - other associations

P - prior HAs different

Onset

  • Sudden Onset (thunder clap HA - HA peaks in a few seconds
  • Age >50 years old

Headache Red Flags

Other Associated Symptoms

  • Awakens from sleep
  • Head trauma
  • Worsened by Valsalva maneuvers
  • Symptoms of GCA (visual disturbances, jaw claudication, temporal artery tenderness, proximal myalgias)
  • Halos around lights

Prior HAs

Prior headache history is different

  • Different pattern from before
  • HA are rapidly progressive in severity or frequence

By

Jennifer Cotton

Neurologic Signs

& Symptoms

Hemorrhagic Stroke

"Red flags" for the presence of serious underlying disorders as a cause of acute or subacute headache

Subdural Hematoma

Epidural Hematoma

  • Encephalitis
  • Subdural hematoma
  • Subarachnoid or intracerebral hemorrhage
  • Tumor
  • Increased intracranial pressure

Intracranial Hypertension

Causes of Red Flag Headaches

Immunosuppression or cancer

  • CNS infection
  • Metastases

Intracranial Mass

Systemic symptoms

  • Sepsis
  • Cancer

Meningismus

triad of nuchal rigidity (neck stiffness), photophobia (intolerance of bright light) and headache

  • Meningitis
  • Subarachnoid hemorrhage
  • Subdural empyema

Herpes Encephalitis

References

Thunder Clap HA

Halos Around Lights

  • Subarachnoid hemorrhage
  • Acute angle-closure glaucoma

1) Venkatesan, A. Case 13: A Man With Progressive Headache and Confusion. Medscape. July 27, 2006. [http://www.medscape.com/viewarticle/537504_1 , accessed 1/21/14]

2) Clintch, CR. Evaluation of Acute Headaches in Adults. Am Fam Physician. 2001 Feb 15;63(4):685-693.

3) Silberstein, SD. Approach to the Patient With Headache. The Merck Manual for Healthcare Professionals. October 2013.

Visual Disturbances, Jaw Claudication, Temporal Artery Tenderness

Temporal Arteritis

  • Temporal Arteritis
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