. 2021 Apr 10;11(2):283–296. doi: 10.1016/j.afjem.2020.11.004

Table 7.

Red flags in children with headache and acute abdominal pain.

Headache [67,68]	Acute abdominal pain [69,70]
1. Sudden onset of headache (first or worst ever) 2. Occipital or cluster headache 3. Early morning headache 4. Headache associated with nausea or severe vomiting, especially in early morning 5. Pain that wakes the child from sleep or occurs on waking 6. Worsening of pain in recumbent position or with cough, straining or other Valsalva manoeuvre 7. Change of the character or increased severity of headache in patients diagnosed with primary headache 8. Altered conscious state 9. Changes in mood or personality over days or weeks 10. Neurological dysfunction, cranial nerve palsies, neck stiffness, photophobia, phonophobia, projectile vomiting, positive Kernig's sign, positive Brudzinski's sign 11. Abnormal ocular movements, squint, pathologic pupillary responses 12. Visual field defects 13. Ataxia, gait abnormalities, impaired coordination 14. Seizures or fever 15. Increased head circumference 16. Papilledema 17. Poor general condition 18. Age < 5 years 19. High-risk population (e.g., patients with sickle cell anaemia, malignancy, recent head trauma, ventricular-peritoneal shunt)	1. Septic appearance (fever, tachycardia, anorexia, generally unwell) 2. Respiratory symptoms (tachypnoea, respiratory distress, cough) 3. Generalised oedema (suspect nephrotic syndrome) 4. Significant dehydration (clinically or > 5% weight loss) 5. Purpuric rash (suspect sepsis if febrile or Henoch-Schonlein purpura if afebrile) 6. Jaundice 7. Peritoneal pain (guarding, generalised or localized rebound tenderness and/or abnormal bowel sounds) 8. Faecal vomiting 9. Bilious (green) vomiting 10. Blood in stool 11. History of recent significant abdominal trauma 12. History of recent abdominal surgery 13. Abdominal pain radiating to back 14. Irreducible hernia 15. Testicular torsion (loss of the cremasteric reflex, diffuse testicular tenderness, elevated testes, and a horizontal rather than vertical position of the testes) 16. Severe or increasing abdominal pain 17. Nonmobile, or change in gait pattern due to pain 18. Abdominal distension 19. Palpable abdominal mass 20. Vaginal bleeding/discharge 21. Polyuria/polydipsia (suspect diabetes mellitus) 22. Age < 5 years (except irreducible, testicular hernia, torsion or recent abdominal injury)

Headache [67,68]

Acute abdominal pain [69,70]

1.
Sudden onset of headache (first or worst ever)
2.
Occipital or cluster headache
3.
Early morning headache
4.
Headache associated with nausea or severe vomiting, especially in early morning
5.
Pain that wakes the child from sleep or occurs on waking
6.
Worsening of pain in recumbent position or with cough, straining or other Valsalva manoeuvre
7.
Change of the character or increased severity of headache in patients diagnosed with primary headache
8.
Altered conscious state
9.
Changes in mood or personality over days or weeks
10.
Neurological dysfunction, cranial nerve palsies, neck stiffness, photophobia, phonophobia, projectile vomiting, positive Kernig's sign, positive Brudzinski's sign
11.
Abnormal ocular movements, squint, pathologic pupillary responses
12.
Visual field defects
13.
Ataxia, gait abnormalities, impaired coordination
14.
Seizures or fever
15.
Increased head circumference
16.
Papilledema
17.
Poor general condition
18.
Age < 5 years
19.
High-risk population (e.g., patients with sickle cell anaemia, malignancy, recent head trauma, ventricular-peritoneal shunt)

1.
Septic appearance (fever, tachycardia, anorexia, generally unwell)
2.
Respiratory symptoms (tachypnoea, respiratory distress, cough)
3.
Generalised oedema (suspect nephrotic syndrome)
4.
Significant dehydration (clinically or > 5% weight loss)
5.
Purpuric rash (suspect sepsis if febrile or Henoch-Schonlein purpura if afebrile)
6.
Jaundice
7.
Peritoneal pain (guarding, generalised or localized rebound tenderness and/or abnormal bowel sounds)
8.
Faecal vomiting
9.
Bilious (green) vomiting
10.
Blood in stool
11.
History of recent significant abdominal trauma
12.
History of recent abdominal surgery
13.
Abdominal pain radiating to back
14.
Irreducible hernia
15.
Testicular torsion (loss of the cremasteric reflex, diffuse testicular tenderness, elevated testes, and a horizontal rather than vertical position of the testes)
16.
Severe or increasing abdominal pain
17.
Nonmobile, or change in gait pattern due to pain
18.
Abdominal distension
19.
Palpable abdominal mass
20.
Vaginal bleeding/discharge
21.
Polyuria/polydipsia (suspect diabetes mellitus)
22.
Age < 5 years (except irreducible, testicular hernia, torsion or recent abdominal injury)