Symptoms related to intracranial cause of headache
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headache AND red flags
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headache red flags intracranial secondary headache guideline
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Features suggesting an intracranial secondary cause of headache include:
- Sudden, maximal-at-onset (“thunderclap”) headache: possible subarachnoid hemorrhage or other vascular emergency.
- New or progressively worsening headache, especially a change from a previous pattern.
- Headache worse on waking, when lying flat, coughing, straining, or bending forward: can indicate raised intracranial pressure.
- Persistent vomiting, particularly early-morning vomiting, or nausea with worsening headache.
- Visual symptoms: transient visual obscurations, double vision, visual-field loss, or blurred vision. Papilledema is an important examination finding.
- Focal neurological symptoms/signs: weakness, numbness, speech difficulty, imbalance, facial droop, seizures, or altered sensation.
- Altered mental status or personality/cognitive change: confusion, drowsiness, memory decline, behavior change.
- Seizure with a new headache.
- Fever and neck stiffness, rash, or photophobia: suggests CNS infection or subarachnoid hemorrhage.
- Headache after head injury, especially with vomiting, reduced consciousness, or anticoagulant use.
- New headache after age 50, or in a person with cancer, HIV/immunosuppression, pregnancy/postpartum state, or clotting risk.
- Headache precipitated by exertion or sexual activity, particularly if abrupt or new.
These are often summarized by SNOOP-type red flags: systemic illness, neurologic deficit, sudden onset, older age at onset, and pattern change/positional or pressure-related features. A normal-looking headache can still be secondary, so the neurologic examination and fundoscopy matter. AAFP red-flag review and acute headache approach outline these warning features.
Seek emergency assessment now for thunderclap headache, new neurological deficit, seizure, confusion/reduced consciousness, fever with neck stiffness, or severe headache after trauma.
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