Headache Signs and Symptoms
Introduction
- Very common problem presenting to primary care clinicians and neurologists
- Almost half of adults worldwide experiences headache and 30% of them have migraine headache
- Commonly affects individuals 25-55 years old, with an estimated lifetime prevalence between 0.2%-60%
- Most common primary headache is tension-type headache while cluster headache is relatively common affecting about 1 in 1,000 adults worldwide
Red Flag Signs and Symptoms
Further evaluation and/or referral is needed
- Worsening headache
- Headache with fever and neck stiffness
- Thunderclap headache
- Sudden-onset of severe headache reaching maximum intensity within seconds to minutes
- First or worst headache of the patient’s life (eg possible subarachnoid hemorrhage)
- New-onset headache with:
- Signs of systemic illness
- Compromised immunity (eg caused by human immunodeficiency virus or immunosuppressive drug)
- Age <20 years old and a history of malignancy
- Age >50 years old with symptoms suggestive of temporal arteritis
- Elderly patient with subacute cognitive change (eg possible subacute or chronic subdural hematoma)
- History of malignancy known to metastasize to the brain
- Vomiting without other obvious cause
- Lyme disease
- New-onset of severe headache in pregnancy or postpartum
- Focal neurologic signs (not typical aura)
- New-onset neurological deficit or cognitive dysfunction
- Change in personality
- Impaired level of consciousness
- Recent head trauma (within the past 3 months)
- Headache triggered by cough, sneeze, or valsalva
- Headache triggered by exercise, exertion, or sexual intercourse
- Rapid onset with strenuous exercise
- Orthostatic headache
- Symptoms suggestive of giant cell arteritis
- Papilledema with altered level of consciousness and/or focal signs
- Papilledema in an alert patient without focal neurological signs (eg possible pseudotumor cerebri)
- Symptoms and signs of acute narrow-angle glaucoma
- Eg non-reactive mid-dilated pupil, acutely inflamed eye, and visual disturbance with pain and nausea
- Substantial change in the characteristics of the headache