Identify Red Flags (Worrisome Features):
- Sudden onset ("thunderclap" headache) – may indicate subarachnoid hemorrhage.
- Worsening or progressive headache – could suggest tumor, infection, or vascular issues.
- New onset in older adults (e.g., >50 years) – consider temporal arteritis.
- Abnormal neurological signs (e.g., focal weakness, confusion, seizures) – may indicate stroke, tumor, or infection.
- Systemic symptoms (e.g., fever, stiff neck, rash) – suggests infection (e.g., meningitis).
- Headache triggered by exertion, cough, or Valsalva – may indicate intracranial pathology (e.g., mass, hemorrhage).
- History of cancer or immunosuppression – higher risk for metastatic disease or opportunistic infections.
- Recent head trauma – risk of subdural hematoma or concussion.
- Rationale: These features help distinguish secondary headaches (potentially serious) from primary headaches (e.g., tension, migraine).
- Key Diagnostic Steps:
- History: Focus on onset, duration, triggers, associated symptoms, and past medical history.
- Examination: Check for fever, neck stiffness, focal neurological deficits, and signs of systemic illness.
- Imaging: Consider CT or MRI for suspected structural causes (e.g., tumor, hemorrhage).
- Lumbar Puncture (LP): If meningitis or subarachnoid hemorrhage is suspected (after ruling out increased intracranial pressure).
- Blood Tests: Check for infections (e.g., CRP for temporal arteritis) or metabolic disorders.
- Rationale: These steps help confirm or rule out secondary causes.
- When to Refer/Escalate:
- If red flags are present, refer to neurology or emergency care for further workup.
- If symptoms persist despite treatment, reassess for missed secondary causes.
- Rationale: Early intervention is critical for serious conditions like meningitis or stroke.
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