Table 6.

Warning signs in children with headache (red flags).

Red flags

Changes in mood or personality over days or weeks Related to severe vomiting, especially in early morning Worsening of pain with cough or Valsalva maneuverAltered conscious state Papilledema Focal neurologic deficit or meningismus Seizures or fever High-risk population (patients with sickle cell anemia., malignancy, recent head trauma, ventricular-peritoneal shunt, others) Pain that wakes the c.hild from sleep or occurs on waking Change of the character of headache in patients diagnosed with primary headache Poor general condition Increased head circumference Cranial nerve palsies Abnormal ocular movements, squint, pathologic pupillary responses Visual field defects Ataxia, gait abnormalities, impaired coordination Sudden onset of headache (first or worst ever) Increase in severity or characteristics of the headache Occipital headache* Age < 5 years*

Modified by Roser et al. (36);

^*relative red flags.