Red Flags in Headache

When I first see a patient, one of the most important things to determine is- is this a primary headache or a secondary headache. What is the difference?

A secondary headache happens when the headache is a "symptom" of another disease. For example, if someone has a tumor, they may develop headaches along with other symptoms as well. In this case, the headache is a sign of something else that is the main disease. It is important to make this distinction in order to pick up another life threatening disorder.

In a primary headache, the headache is the disease itself. These occur in primary headache diseases like migraine or cluster headache. In these cases, the headache is not being caused by another disease but is the disease itself.

There are several clues in the patient's history and/or physical that can help to determine whether the headache may be a clue to another disorder and therefore warrant more work up, including an MRI or other types of imaging.

A useful mnemonic to remember to help determine if there are red flags in someone with a headache is SNOOP.

S- "Systemic Symptoms"- If someone also has other systemic symptoms, like fevers, weight loss or others, this can be a sign that further work up is needed.

N- "Neurological signs"- if there are focal signs on the exam, that is also very concerning. These can include numbness or weakness on one side of the body, along with others.

O-"older age"- most of the primary headaches first begin in younger age, therefore if someone who is older, over the age of 50 presents with new headaches, this warrants further work up.

O-“onset” refers to how quickly the headache comes on. If someones headache comes on as "thunderclap," which means one that is very severe over seconds or is described as the “worst headache of a person’s life” this is concerning for a headache that could be life-threatening and warrants quick attention.

P- “Pattern” or headaches that change with “position”,these also requires more looking into. Other possible worrisome headaches are ones that wake someone up from sleep or are first present when someone wakes up in the morning.

Although most headaches will be due to a primary issue like migraine, it is important to keep these in mind and be alert to possible other causes.

🚩Have you heard of these red flags before 🚩.