Table 5 Specific warning features (“red flags”) in the history
From: Aids to management of headache disorders in primary care (2nd edition)
Warning feature | What to beware of |
|---|---|
Thunderclap headache (intense headache with “explosive” or abrupt onset) | Subarachnoid haemorrhage |
Headache with atypical aura (duration >1 h, or including motor weakness) | TIA or stroke |
Aura without headache in the absence of a prior history of migraine with aura | TIA or stroke |
Aura occurring for the first time in a patient during use of combined hormonal contraceptives | Risk of stroke (requires discontinuation) |
New headache within 3 months of head trauma | Subdural haematoma |
Progressive headache, worsening over weeks or longer | Intracranial space-occupying lesion |
Headache aggravated by postures or manoeuvres that raise intracranial pressure | Intracranial space-occupying lesion |
Headache brought on by coughing, exercise or sexual activity | Intracranial space-occupying lesion |
Mild-to-moderate progressive or recurrent headache with irritability, dizziness (light-headedness), nausea and/or tiredness and confusion | Carbon monoxide poisoning |
Headache associated with unexplained focal neurological symptoms or with epileptic seizures | Suggests secondary headache |
Headache associated with change in memory or personality | Suggests secondary headache |
Headache associated with weight-loss | Suggests secondary headache |
New headache in a patient older than 50 years | Temporal arteritis or intracranial tumour |
New headache in a patient with a history of cancer or immunodeficiency (including HIV infection) | Likely to be secondary headache |
New headache in a patient with a history of polymyalgia rheumatica | Temporal (giant cell) arteritis |
New headache in a patient with a family history of glaucoma | Glaucoma |