Headache or migraine: How to spot the red flags

Not all headache or migraine symptoms in children signify red flags that require additional referrals or advanced treatment

Not all headache or migraine symptoms in children signify red flags that require additional referrals or advanced treatment, said Elizabeth S. Doll, M.D., child neurologist at Norton Children’s Neuroscience Institute, affiliated with the UofL School of Medicine.

“There are over 200 different types of headaches, but the majority of what we encounter in clinic are migraines. It is important to be able to distinguish the symptoms of migraines versus other types of headaches that might require more investigation,” Dr. Doll said.

Headache or migraine?

A headache is pain that occurs in any region of the head: one or both sides, a single point, radiating across the head from one location or tight and vice-like (tension headache). Headache pain can be dull, sharp or throbbing with a gradual or sudden onset. Headaches can last from a few minutes to several days.

Migraine involves intense, recurring headaches characterized by severe or throbbing pain, typically on one side of the head. Migraine usually is coupled with nausea and sensitivity to light and sound. A migraine attack can last for hours or days. The pain can be debilitating enough to interfere with regular activities. It is common for patients to experience “aura,” a warning symptom: flashes of light, blind spots, or tingling on one side of the face or body.

Primary vs. secondary causes

Primary headaches are the most common types of headaches, such as tension headaches or migraine, where the medical issue is the headache itself. These headaches are not associated with an underlying medical condition and can be related to inflammation involving the blood vessels, nerves or muscles.

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“The underlying pathophysiology of migraine is much more complicated – it’s not just inflammation,” said Dr. Doll.

Although headaches such as migraine and tension headaches can be painful, they are usually not considered harmful or dangerous. Causes of primary headaches may include medication, dehydration and hormone levels, or triggers such as bright lights, certain foods, stress or changes in sleeping habits.

Secondary headaches are rare and typically occur suddenly; the pain is often excruciating. Causes of secondary headaches may include brain tumors, aneurysms, meningitis or a neck or brain injury. Viral infections, such as cold or flu, also may cause headaches.

Using ‘SNOOP’ to detect “red flags”

The American Headache Society’s “SNOOP” mnemonic helps outline the red flags and warning signs for headaches that would suggest further investigation and/or diagnostic imaging:

  • SYSTEMIC SYMPTOMS (fever, weight loss) OR SECONDARY RISK FACTORS (HIV, systemic cancer, rheumatologic disorders)
  • NEUROLOGIC SYMPTOMS or abnormal signs (confusion, impaired alertness or consciousness)
  • ONSET: sudden, abrupt, or split-second
  • OLDER: new onset and progressive headache, especially in middle age/ages 50 and older (not applicable in children)
  • PREVIOUS HEADACHE HISTORY: first headache or different (change in attack frequency, severity or clinical features)

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