Red flags for secondary headaches: challenges in clinical practice

Authors

DOI:

https://doi.org/10.48208/HeadacheMed.2022.29

Keywords:

Red flags, Secundary headache, SNNOOP10, Review

Abstract

Introduction

The World Health Organization (WHO) ranks migraine as one of the top 20 causes of impaired healthy life years per year worldwide. Migraine alone is responsible for about 400,000 lost workdays per year per one million inhabitants in developed countries. Headache is probably among the five most important causes of disability worldwide. 

Method

This literature review was carried out by searching the Pubmed, Lilacs and Scopus databases, using the following Health Science Descriptors (DeCS) of the Virtual Health Library and in particular the current data collected by the WHO or health entities in the various countries: "secondary headaches" AND "red flags" AND "review". Articles published in Portuguese and English were selected. The eligibility criteria defined for the inclusion of articles were studies that addressed the chosen theme. 

Results

The use of "Red Flags" in clinical practice is of considerable relevance. The combination of "Red Flags", anamnesis, physical examination, laboratory, and imaging examination accentuate the probability of predicting the etiology that may underlie the onset of a secondary headache.  However, despite this widely useful screening tool, there are still gaps in the prognosis. 

Conclusion

Much remains unclear as there is a lack of prospective epidemiological studies. In addition, some "Red Flags" such as pattern change are poorly elucidated. Large-scale studies are needed due to the low incidence of many secondary causes. New patients with headache should be screened using the SNNOOP10 list to increase the likelihood of detecting a secondary cause.

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References

European Headache Federation. Princípios europeus de abordagem de cefaleias comuns nos cuidados de saúde primários Lisboa: Sociedade Portuguesa de Cefaleia; 2010. 47 p.

Souza NE, Calumby ML, Afonso EdO, Nogueira TZS and Pereira ABC. Cefaleia: migrânea e qualidade de vida. Rev Saúde 2016;6(2):23-26 Doi:10.21727/rs.v6i2.55 DOI: https://doi.org/10.21727/rs.v6i2.55

Ministério da Saúde. Acolhimento à demanda espontânea: queixas mais comuns na Atenção Básica. 1 ed. Brasília: Ministério da Saúde; 2013. 28 p.

Filler L, Akhter M and Nimlos P. Evaluation and Management of the Emergency Department Headache. Semin Neurol 2019;39(1):20-26 Doi:10.1055/s-0038-1677023 DOI: https://doi.org/10.1055/s-0038-1677023

May A. Hints on Diagnosing and Treating Headache. Dtsch Arztebl Int 2018;115(17):299-308 Doi:10.3238/arztebl.2018.0299 DOI: https://doi.org/10.3238/arztebl.2018.0299

Silva WF. Manual prático para o diagnóstico e tratamento das cefaleias. 2 ed. Rio de Janeiro: Sociedade Brasileira de Cefaleia; 2001.

Singh A and Soares WE. Management strategies for acute headache in the emergency department. Emerg Med Pract 2012;14(6):1-23; quiz 23-24

Jordan JE, Ramirez GF, Bradley WG, Chen DY, Lightfoote JB and Song A. Economic and outcomes assessment of magnetic resonance imaging in the evaluation of headache. J Natl Med Assoc 2000;92(12):573-578

Finucane LM, Downie A, Mercer C, Greenhalgh SM, Boissonnault WG, Pool-Goudzwaard AL, . . . Selfe J. International Framework for Red Flags for Potential Serious Spinal Pathologies. J Orthop Sports Phys Ther 2020;50(7):350-372 Doi:10.2519/jospt.2020.9971 DOI: https://doi.org/10.2519/jospt.2020.9971

Welch E. Red flags in medical practice. Clin Med (Lond) 2011;11(3):251-253 Doi:10.7861/clinmedicine.11-3-251 DOI: https://doi.org/10.7861/clinmedicine.11-3-251

Anzaldua D. An Acupuncturist’s Guide to Medical Red Flags & Referrals. Boulder, CO: Blue Poppy Press; 2010.

Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J and Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010;19(12):2075-2094 Doi:10.1007/s00586-010-1502-y DOI: https://doi.org/10.1007/s00586-010-1502-y

Mitsikostas DD, Ashina M, Craven A, Diener HC, Goadsby PJ, Ferrari MD, . . . Martelletti P. European Headache Federation consensus on technical investigation for primary headache disorders. J Headache Pain 2015;17:5 Doi:10.1186/s10194-016-0596-y DOI: https://doi.org/10.1186/s10194-016-0596-y

Clarke CE, Edwards J, Nicholl DJ and Sivaguru A. Imaging results in a consecutive series of 530 new patients in the Birmingham Headache Service. J Neurol 2010;257(8):1274-1278 Doi:10.1007/s00415-010-5506-7 DOI: https://doi.org/10.1007/s00415-010-5506-7

Dodick DW D. Clinical clues and clinical rules: primary vs secondary headache. Advanc Studies Med 2003;3(6 C):S550-555

Do TP, Remmers A, Schytz HW, Schankin C, Nelson SE, Obermann M, . . . Schoonman GG. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology 2019;92(3):134-144 Doi:10.1212/wnl.0000000000006697 DOI: https://doi.org/10.1212/WNL.0000000000006697

Paradowska-Stankiewicz I and Piotrowska A. Meningitis and encephalitis in Poland in 2014. Przegl Epidemiol 2016;70(3):349-357

Limper AH, Knox KS, Sarosi GA, Ampel NM, Bennett JE, Catanzaro A, . . . Stevens DA. An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med 2011;183(1):96-128 Doi:10.1164/rccm.2008-740ST DOI: https://doi.org/10.1164/rccm.2008-740ST

van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB and Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;351(18):1849-1859 Doi:10.1056/NEJMoa040845 DOI: https://doi.org/10.1056/NEJMoa040845

Lamont AC, Alias NA and Win MN. Red flags in patients presenting with headache: clinical indications for neuroimaging. Br J Radiol 2003;76(908):532-535 Doi:10.1259/bjr/89012738 DOI: https://doi.org/10.1259/bjr/89012738

García-Azorín D, Do TP, Gantenbein AR, Hansen JM, Souza MNP, Obermann M, . . . Kristoffersen ES. Delayed headache after COVID-19 vaccination: a red flag for vaccine induced cerebral venous thrombosis. J Headache Pain 2021;22(1):108 Doi:10.1186/s10194-021-01324-5 DOI: https://doi.org/10.1186/s10194-021-01324-5

García-Azorín D, Trigo J, Talavera B, Martínez-Pías E, Sierra Á, Porta-Etessam J, . . . Guerrero Á L. Frequency and Type of Red Flags in Patients With Covid-19 and Headache: A Series of 104 Hospitalized Patients. Headache 2020;60(8):1664-1672 Doi:10.1111/head.13927 DOI: https://doi.org/10.1111/head.13927

Callaghan BC, Kerber KA, Pace RJ, Skolarus LE and Burke JF. Headaches and neuroimaging: high utilization and costs despite guidelines. JAMA Intern Med 2014;174(5):819-821 Doi:10.1001/jamainternmed.2014.173 DOI: https://doi.org/10.1001/jamainternmed.2014.173

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Published

2022-12-31

How to Cite

1.
Lima MCM, Maioli GS, Valença MM. Red flags for secondary headaches: challenges in clinical practice. Headache Med [Internet]. 2022 Dec. 31 [cited 2024 Dec. 14];13(4):242-8. Available from: https://www.headachemedicine.com.br/index.php/hm/article/view/740

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Review

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