Red Flag Symptoms of Migraines
Key Red Flags in Patient History
- The American Academy of Family Physicians suggests that thunderclap headache, which is a sudden onset headache reaching maximum intensity within seconds to minutes, may indicate subarachnoid hemorrhage 1
- A marked change in headache pattern, significant change in previously stable headache characteristics, requires further investigation 1
- Headache aggravated by Valsalva maneuvers, such as coughing, sneezing, or exercise, could indicate increased intracranial pressure 2, 1
- Headache onset after age 50 suggests secondary headache and consideration of temporal arteritis 1
- Persistent headache following head trauma may indicate intracranial injury 2, 1
Red Flags on Physical Examination
- Focal neurological signs suggest secondary headache and require urgent evaluation 2, 1
- Papilledema indicates increased intracranial pressure 3
- Uncoordination may indicate cerebellar pathology 2, 1
Clinical Significance and Approach
- The American Academy of Neurology suggests that neuroimaging should be considered in patients with migraine who have atypical headache patterns or neurologic signs 2
- Neuroimaging is indicated when red flags are present to rule out secondary causes of headache 1