Tiny Tips: HEADACHe Red Flags Mnemonic

Patients with complaints of acute headache comprise 4% of emergency department visits.¹ Most headaches presenting to the ED are primary headaches such as migraines, however, important secondary causes, such as hemorrhage, cannot be missed.². A recent CrackCast outlined an excellent approach to headache red flags.

The HEADACHe mnemonic can help you remember these red flags³!

History describing the worst headache of life or a headache that is different than usual
Exertion as a trigger for the headache
Age greater than 50 years
Despite treatment, headache persists
Acute onset
Central nervous system findings
HIV or other immunocompromise
fEver or other systemic symptoms

This post was copy-edited by S. Luckett-Gatopoulos (@SLuckettG) and Dat Nguyen-Dinh (@dat_nd).

References

Bounes V, Edlow J. Migraine: diagnosis and pharmacologic treatment in emergency department. Eur Rev Med Pharmacol Sci. 2011;15(2):215-221. [PubMed]

Hainer B, Matheson E. Approach to acute headache in adults. Am Fam Physician. 2013;87(10):682-687. [PubMed]

Cline D M, Ma O John, Meckler G, Tintinalli J, Stapczynski J, Yealy D. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8th Edition. McGraw-Hill Education / Medical; 2015.

Reviewing with the Staff

The above mnemonic is a reasonable approach to ensuring that many of the red flag presentations of headache are considered. While advanced learners should have an appropriate headache history and physical exam that is driven by a differential, junior learners would do well to ensure that each of these items is reviewed as they are often features of a dangerous headache. Each of the findings must be reviewed in context as, alone, none of them are sensitive or specific enough to determine an investigation or treatment plan.