Table 2 Anamnestic and clinical red flags in sudden onset headaches
From: Sudden onset headaches in paediatric emergency departments: diagnosis and management
Anamnestic red flags |
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- High-risk population: sickle cell anaemia, malignancy, ventricular-peritoneal shunt, neurocutaneous disease, coagulopathy etc. - Age < 5 years - Recent changes in mood or personality - Recent head trauma - Altered general condition, weight loss - Occipital pain - Pain that wakes the child from sleep or worst when waking up, - Pain worsened by coughing or Valsalva maneuver. - Changes in headache characteristics of a child diagnosed with primary headaches - Association with severe vomiting, particularly in the morning - Blurred vision or gait abnormalities - Seizures |
Physical examination red flags |
- Altered conscious state - Meningism - Visual field defects, papilloedema, abnormal ocular movements, pathological pupillary responses - Focal neurological deficit - Cranial nerve palsy - Ataxia, walking abnormalities, impaired coordination - Increased head circumference - Hypertension, bradycardia |