Author: Arun Venkatesan, MD, PhD Preceptor: Michael A. Williams, MD


July 27, 2006

Headache "Red Flags"

"Red flags" for the presence of serious underlying disorders as a cause of acute or subacute headache can be remembered by using the mnemonic SNOOP:

Systemic symptoms or illness (including fever, persistent or progressive vomiting, stiff neck, pregnancy, cancer, immunocompromised state, anticoagulated);

Neurologic signs or symptoms (including altered mental status, focal neurologic symptoms or signs, seizures, or papilledema);

Onset is new (especially in those age 40 years or older) or sudden;

Other associated conditions (eg, headache is subsequent to head trauma, awakens patient from sleep, or is worsened by Valsalva maneuvers);

Prior headache history that is different (eg, headaches now are of different pattern or are rapidly progressive in severity or frequency).

When such red flags are present, neuroimaging (computed tomography [CT] or MRI) is indicated to investigate secondary causes of headache.


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