Interpretation: Red Flags imply serious cause
1. See Organic Headache
2. See Acute Generalized Headache
Signs and Symptoms: Headache, Severe and incapacitating
1. No prior history or Family History of Headaches
  1. Especially Headache onset after age 40-50 years
2. Change in Headache pattern
3. Progressive in frequency or severity
4. Headache awakens patient from sleep
5. Occipital or frontal focal Headache
6. Provocative factors
  1. Exertion
  2. Cough or other Valsalva maneuvers
  3. Sex
Signs and Symptoms: Associated
1. Vomiting, Persistent and Progressive
2. Persistent Constitutional or Meningeal Symptoms
  1. Fever
  2. Stiff neck
  3. Chronic malaise, myalgias or arthralgias
3. Focal neurologic signs
  1. Progressive visual disturbance
  2. Weakness, clumsiness, or loss of balance
4. Papilledema
5. Photophobia or Phonophobia
6. Seizure history
7. Headache occurring after Head Trauma
Mnemonic: SNOOP
1. Systemic symptoms or illness
  1. Fever
  2. Altered Level of Consciousness
  3. Anticoagulation
  4. Pregnancy
  5. Cancer
2. Neurologic symptoms or signs
  1. Papilledema
  2. Asymmetric Cranial Nerve function
  3. Asymmetric motor function
  4. Abnormal Cerebellar Function
3. Onset recently or suddenly
4. Onset after age 40 years
5. Prior Headache History that is different or progressive
6. References
  1. Dodick (2003) Adv Stud Med S550-5
References

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 8/14/2009. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.