Red Flag Symptoms

Certain features of the presentation may be regarded as ‘red flags’ and serve to expedite the management of patients with new-onset headache.

These are shown below:

Table 1 Possible causes of red flag symptoms
Red Flag Symptom Possible Cause
Headache in a person of age >50 years Mass lesion, temporal arteritis
‘Thunderclap’ headache SAH, pituitary apoplexy, haemorrhage into mass lesion or vascular malformation, posterior fossa mass lesion
Headaches increasing in severity and frequency Mass lesion, subdural haematoma, medication overuse
Headache with fever, neck stiffness, or reduced level of consciousness Meningitis, encephalitis, cerebral vasculitis
Focal neurological symptoms or signs Mass lesion, vascular malformation, stroke
Papilloedema Mass lesion, benign intra-cranial hypertension
Headache after trauma Intra-cranial haemorrhage: subarachnoid, extradural, subdural, concussion

Learning Bite

Mass lesions have the greatest variety of presentations – effectively mimicking almost all other causes of non-traumatic headache.

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