🧠 Headache · Migraine vs Tension vs Secondary · Red Flags Tool

Schwartz Clinical Handbook — Chapter 38 · Migraine with/without aura · Tension headache · Pseudotumor · Brain tumor · Sinusitis

Select pain quality (throbbing, pressing), location (bilateral, unilateral, occipital), associated symptoms (nausea, photophobia, phonophobia, aura, autonomic signs), and red flags (new onset severe, waking from sleep, focal deficit, papilledema) → differentiate migraine, tension headache, cluster, or secondary headache.
⚠️ Red flags (SNOOP): Systemic symptoms, Neurologic deficit, Onset after 50yr (or <3yr), Onset sudden (thunderclap), Prior headache history change, Positional headache, Precipitated by Valsalva, Papilledema.

📋 Step 1 — Headache characteristics & red flags
📌 Diagnostic impressions
📖 Schwartz Ch 38

Select pain quality (throbbing vs pressing), duration (4‑72h vs minutes to days), location, associated features (nausea/vomiting, photophobia, phonophobia, aura, autonomic signs), and red flags → system applies ICHD‑3 criteria for migraine, tension, cluster, and secondary headaches (sinusitis, pseudotumor, tumor).

✔️ Migraine: 4‑72h, unilateral, throbbing, nausea, photophobia, +/‑ aura.
✔️ Tension: bilateral, pressing/ tightening, no nausea, no moderate‑severe aggravation.
✔️ Cluster: severe periorbital, autonomic symptoms (tearing, rhinorrhea).
✔️ Red flags: first/worst headache, nocturnal awakening, focal signs, seizure → MRI.
📘 Schwartz pearls (Chapter 38)
• Migraine: treat acute ibuprofen/dihydroergotamine/triptans (≥12y). Prophylaxis: cyproheptadine, amitriptyline, topiramate.
• Tension headache: reassurance, stress management, amitriptyline if chronic.
• Pseudotumor cerebri: papilledema, elevated opening pressure, acetazolamide.
• MRI indicated for progressive headache, focal signs, or posterior fossa symptoms.