Skip to main content

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