Red flags in headache presentations : an alphabetical guide

Abstract

Headache is the prototypical neurological complaint – an intrusive and limiting symptom that is subjective in its severity, intangible in nature and extremely difficult to quantify or measure. It is also by far the most commonly experienced neurological symptom, occurring as either a primary disorder or secondary to another systemic illness. Its high prevalence across populations regardless of race, gender, age and geographical distribution reflects its generally benign nature and outcome, but results in difficulty in identifying the small minority of individuals whose headaches are underpinned by serious or potentially life-threatening conditions. This leads to concern among medical specialists and primary care physicians alike, often exposed to ‘headache fatigue’ from regularly evaluating patients with this complaint, about missing serious headache cases and on how to judiciously apply finite health resources including imaging across this large population of patients. There are a number of headache guidelines that indicate specific patient characteristics, accompanying symptoms or signs, and other ‘red flags’ that may either indicate the need for investigation or point towards an underlying cause. While a comprehensive review of these documents is beyond the scope of this short article, hereunder are summarised alphabetically many of the readily identified markers for secondary causes of headache that may be swiftly assessed for and hopefully discounted in a physician-patient encounter.