Primary and Secondary Headaches - Red Flags and Differential Diagnosis

Red Flags (SNOOP):

S - Systemic		

N - Neurologic Sx	

O - Onset New, Sudden	

O - Other Associated			

P - Previous Headache Sx change	

Migraine Headache:

 • Unilateral (60-70%), Bifrontal or Global (30%)	

 • Gradual, Crescendo, Pulsating, Mod-Severe Intensity	

 • Patient Prefers to Rest, Dark	

 • 4h – 3 days

 • N/V, Photophobia, Phonophobia +/- aura (usually visuals)

Tension Headache:

 • Bilateral

 • Pressure or Tightness which Waxes and Wanes

 • 30 min – 7 days	

Cluster Headache:

 • Always unilateral		

 • Around Eye/Temple

 • Pain comes quickly, deep pain, continuous, excruciating, explosive	

 • 15 min – 3 hr	

 • Ipsilateral Lacrimation, Red Eye, Stuffy Nose, Pallor, Sweating, Focal Neurological Sx, Sensitivity ETOH

Infection - Meningitis

Trauma - Post-Trauma, Neck Manipulation 

Vascular - Subarachnoid Hemorrhage, Subdural hematoma, epidural hematoma, Pituitary Apoplexy, Venous Thrombosis, Giant Cell Arteritis, Carotid/Vertebral Dissection, AV Malformation 

Non-Vascular - Increased/Decreased ICP, Neoplasm, Seizure  

Substance - Carbon monoxide, ETOH, Cocaine, Histamine, Substance Withdrawal 

Infection - Meningitis, Encephalitis, Abscess

Homeostasis - Hypoxia, Hypercapnia, Hypoglycemia  

Anatomy - Acute Glaucoma, Physiological



- Amy Chung, MD, MSc @AmyChung 



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