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
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
Intracranial Mass
Systemic symptoms
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
- 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