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Risk factors for serious pathology (also known as red flags)

Conduct an appropriate clinical evaluation to rule out major structural or other pathologies as the cause of the symptoms.

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Risk factors/red flags may include:​

• worsening headache with fever

• sudden-onset headache (thunderclap) reaching maximum intensity within 5 minutes

• new onset neurological deficit 

• new onset cognitive dysfunction

• change in personality 

• impaired level of consciousness 

• recent (within the last 3 months) head trauma

• headache triggered by exertion (e.g. cough, valsalva maneuver, sneeze, exercise)

• headache that changes with posture 

• symptoms suggestive of giant cell arteritis

• symptoms and signs of acute narrow-angle glaucoma 

• a substantial change in the characteristics of the patient's headache 

• new onset or change in headache of patients who are over 40 years of age and older 

• headache wakening the patient up (migraine is the most frequent cause of morning headache)

• patients with risk factors for cerebral venous sinus thrombosis

• jaw claudication or visual disturbance

• neck pain or stiffness

• limited neck flexion upon examination

• new onset headache in patients with a history of human immunodeficiency virus (HIV) infection

• new onset headache in patients with a history of cancer 

Are risk factors present?

No

No

No

Yes

Yes

Yes

No

Yes

Yes

No

Literature search updated April 2015