RED FLAGS
Red flags are specific history, symptoms, or signs that are often associated with secondary
headaches. However, they may
also occur in primary headaches. Importantly, red flags may suggest underlying causative
disorders and heighten
awareness of secondary headaches. A combination of compatible red flags may increase their
significance.
The red flags used in the VTD HEADACHE ASSESSMENT are listed below, along with their
suggested possible disorders
(SNNOOP10) [ref.1,2].
Systemic symptoms including fever
• Fever : infections
Neoplasm in history
• Neoplasm (health problem) :
neoplasms, metastasis
Neurologic deficit or dysfunction including decreased consciousness
• Neurologic deficit • Seizure : vascular
or
nonvascular disorders, infections
Onset of headache is sudden or abrupt
• Sudden and severe : subarachnoid
hemorrhage,
vascular disorders
Older age (after 50 years)
• Age onset (years) > 50
: neoplasms, vascular or nonvascular disorders, giant cell
arteritis
Pattern Change or recent onset of new headache
• First attack • Newly developed (< 3 months)
: neoplasms, vascular or nonvascular disorders
Positional headache
• Changing to upright posture
: intracranial hypotension
Precipitated by sneezing, coughing, or exercise
• Valsalva
: posterior fossa lesions, Chiari malformation
• Exercise or sexual activity (on first occurrence)
: subarachnoid hemorrhage, vascular disorders
• Chewing
: giant cell arteritis, TMJ disorders
Papilledema
• papilledema
: neoplasms, nonvascular disorders, intracranial hypertension
Progressive headache and atypical presentations
• Progressive worsening
: neoplasms, nonvascular disorders
Pregnancy or puerperium
• Pregnancy or puerperium
: hypertension, preeclampsia, eclampsia, cerebral sinus thrombosis,
hypothyroidism, postdural puncture
Painful eye with autonomic features
• Painful eye with autonomic symptoms
: pathology in posterior fossa, pituitary region, or cavernous sinus; Tolosa-Hunt syndrome;
ophthalmic causes
Posttraumatic onset of headache
• Head injury (< 3 months)
: posttraumatic headache, subdural hematoma
Pathology of the immune system such as HIV
• Immunodeficiency • steroids
: opportunistic infections
Painkiller overuse or new drug at onset of headache
• Pain relievers > 10-15 days/month > 3 months
: medication-overuse headache
• Using the drugs underlined on page 2 of the form
: drug-induced headache
• Antiplatelets, anticoagulants
: intracranial hemorrhage