HEADACHES are common, but some can be life-threatening. This flowchart provides a structured approach to identifying red flag headaches that require urgent attention. Let’s break it down:
Thunderclap Headache (sudden, severe pain) → Non-contrast CT scan
If subarachnoid blood is seen → Subarachnoid HemorrhageIf CT is normal → Lumbar punctureXanthochromic CSF? Likely Cerebral Venous Sinus ThrombosisClear CSF? Further imaging (MRI/MRA) needed
Red Flag Signs (Neurological symptoms, visual changes, systemic symptoms) → Brain MRI
If mass lesion → Brain TumorIf clinical signs of Giant Cell Arteritis (GCA) → Temporal artery biopsyIf signs of raised intracranial pressure (ICP) → Idiopathic Intracranial Hypertension
Fever or Stiff Neck? Think Infection!
High risk for cerebral herniation? → Do Head CTIf a mass lesion is found → Brain Abscess
Low risk for cerebral herniation? → Lumbar puncture & blood culturesIf CSF abnormalities → Meningitis → Start empiric antibioticsIf lumbar puncture is non-diagnostic → Do Brain MRInote that not every headache is just a headache! Sudden onset, red flag symptoms, or fever require urgent evaluation. This structured approach ensures we don’t miss critical diagnoses like hemorrhage, tumors, infections, or vascular disorders. !!
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Prepared and Written by Shahnoor Ahmad Khan. !!
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