Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list

Do, T. P.; Remmers, A.; Schytz, H. W.; Schankin, Christoph Josef; Nelson, S. E.; Obermann, M.; Hansen, J. M.; Sinclair, A. J.; Gantenbein, A. R.; Schoonman, G. G. (2019). Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology, 92(3), pp. 134-144. Lippincott Williams & Wilkins 10.1212/wnl.0000000000006697

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A minority of headache patients have a secondary headache disorder. The medical literature presents and promotes red flags to increase the likelihood of identifying a secondary etiology. In this review, we aim to discuss the incidence and prevalence of secondary headaches as well as the data on sensitivity, specificity, and predictive value of red flags for secondary headaches. We review the following red flags: (1) systemic symptoms including fever; (2) neoplasm history; (3) neurologic deficit (including decreased consciousness); (4) sudden or abrupt onset; (5) older age (onset after 65 years); (6) pattern change or recent onset of new headache; (7) positional headache; (8) precipitated by sneezing, coughing, or exercise; (9) papilledema; (10) progressive headache and atypical presentations; (11) pregnancy or puerperium; (12) painful eye with autonomic features; (13) posttraumatic onset of headache; (14) pathology of the immune system such as HIV; (15) painkiller overuse or new drug at onset of headache. Using the systematic SNNOOP10 list to screen new headache patients will presumably increase the likelihood of detecting a secondary cause. The lack of prospective epidemiologic studies on red flags and the low incidence of many secondary headaches leave many questions unanswered and call for large prospective studies. A validated screening tool could reduce unneeded neuroimaging and costs.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Schankin, Christoph Josef

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Panagiota Milona

Date Deposited:

20 Feb 2019 09:39

Last Modified:

20 Feb 2019 09:45

Publisher DOI:

10.1212/wnl.0000000000006697

PubMed ID:

30587518

BORIS DOI:

10.7892/boris.124673

URI:

https://boris.unibe.ch/id/eprint/124673

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