Table 1 Red flags in the diagnosis of headache. Modified from [6]
From: The differential diagnosis of chronic daily headaches: an algorithm-based approach
Red flag | Consider | Possible investigation(s) |
|---|---|---|
Sudden-onset headache | Subarachnoid haemorrhage, bleed into a mass or AVM, mass lesion (especially posterior fossa) | Neuroimaging, lumbar puncture (after neuroimaging evaluation) |
Worsening-pattern headache | Mass lesion, subdural haematoma, medication overuse | Neuroimaging |
Headache with cancer, HIV or other systemic illness (fever, neck stiffness, cutaneous rash) | Meningitis, encephalitis, Lyme disease, systemic infection, collagen vascular disease, arteritis | Neuroimaging, lumbar puncture, biopsy, blood tests |
Focal neurologic signs, or symptoms other than typical visual or sensory aura | Mass lesion, AVM, collagen vascular disease | Neuroimaging, collagen vascular evaluation |
Papilloedema | Mass lesion, pseudotumour, encephalitis, meningitis | Neuroimaging, lumbar puncture (after neuroimaging evaluation) |
Triggered by cough, exertion or Valsalva | Subarachnoid haemorrhage, mass lesion | Neuroimaging, consider lumbar puncture |
Headache during pregnancy or post-partum | Cortical vein/cranial sinus thrombosis, carotid dissection, pituitary apoplexy | Neuroimaging |