Red flags include recent onset, rapidly increasing frequency and severity of headache; headache causing the patient to wake from sleep; associated dizziness, lack of coordination, tingling or numbness, new neurologic deficit; and new onset of a headache in a patient with a history of cancer or immunodeficiency.

Conditions: Headache, Neurologic Deficit

Diagnostic Tests: Head or Brain Imaging, X-Ray, Computed Tomography (CT Scanning), Magnetic Resonance Imaging (MRI)

Sources

• American College of Radiology. Five things physicians and patients should question. 2013 [cited 2014 Mar 12]. (ChoosingWisely)
• Beithon J, Gallenberg M, Johnson K, Kildahl P, Krenik J, Liebow M, et al. Institute for clinical systems improvement. Diagnosis and treatment of headache. 2013 Jan [cited 2014 Feb 23]. (PDF)
• Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW, American College of Emergency Physicians. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008 Oct;52(4):407-36. (PubMed)
• Hayes LL, Coley BD, Karmazyn B, Dempsey-Robertson ME, Dillman JR, Dory CE, et al. ACR appropriateness criteria®: Headache – child. 2012 [cited 2014 Feb 23]. (PDF)
• Health Quality Ontario. Neuroimaging for the evaluation of chronic headaches: An evidence-based analysis. Ont Health Technol Assess Ser. 2010;10(26):1-57. (PubMed)
• Jordan YJ, Lightfoote JB, Jordan JE. Computed tomography imaging in the management of headache in the emergency department: Cost efficacy and policy implications. J Natl Med Assoc. 2009 Apr;101(4):331-5. (PubMed)
• National Institute for Health and Clinical Excellence (NICE). Headaches: Diagnosis and management of headaches in young people and adults. 2012 Sep [2014 Feb 23]. (NICE)
• Sandrini G, Friberg L, Coppola G, Janig W, Jensen R, Kruit M, et al. Neurophysiological tests and neuroimaging procedures in non-acute headache (2nd edition). Eur J Neurol. 2011 Mar;18(3):373-81. (PubMed)
• Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of headache in adults: A national clinical guideline. 2008 Nov [2014 Feb 23]. (PDF)
• Toward Optimized Practice. Guideline for primary care management of headache in adults. 2012 Jul [2014 Feb 23]. (PDF)