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
Central nervous system findings
HIV or other immunocompromise
fEver or other systemic symptoms
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.