Table 3.
Red flags in headache. Life-threatening red flags are in italics.
| Headache Characteristics |
| Pain that wakes the child from sleep or occurs on waking |
| Worsening of headache in recumbency and/or during straining, coughing, and/or other forms of Valsalva maneuver, physical activity |
| Sudden severe headache, thunderclap headache |
| Recurrent localized headache |
| Occipital headache |
| Inadequate response to therapy |
| Changes in headache characteristics (both chronic or acute): intensity, frequency, pattern |
| Chronic progressive headache |
| Clinical and medical history |
| Incomplete medical and clinical history |
| Age < 5 y/o |
| Recent head trauma (<12 h if severe, >12 h if mild) |
| High-risk population (sickle cell anemia, coagulopathy, immunodeficiency, former or present tumor, cardiac diseases with right-left shunt, hydrocephalus or ventricular shunt, type 1 neurofibromatosis, tuberous sclerosis, familiar genetic syndromes) |
| Changes in mood, behavior, or personality * |
| Polyuria, polydipsia |
| Morning/fasting nausea and/or vomiting |
| Growth anomalies (head circumference increase, short stature or growth reduction, precocious/delayed puberty) |
| Neck/rachis symptoms |
| Systemic disease symptoms (weight loss, night sweats, fever, joint pain) |
| Clinical data from physical examination |
| Reduced general condition |
| Neurological signs and symptoms (persistent nausea and/or vomiting, impaired mental state, ataxia, asymmetric, weakness, focal deficits) |
| Motor signs and symptoms (regression of psychomotor development, focal deficits, gait abnormalities, impaired coordination, impaired swallowing) |
| Visual disorders (papilledema, retinal hemorrhage, pathological pupillary response, diplopia, nystagmus or abnormal ocular movements, visual field defects, visual acuity defect reduction unrelated to abnormal ocular refraction) |
| Incompliant child (impossibility to perform physical examination) |
| Neck stiffness or other meningeal signs |
| Trauma |
| Cranial vascular murmur |
| Neurocutaneous markers |
| Macrocephaly |
* In children, changes in mood and behavior might only indicate worsening pain.