Red Flags in Headache History

Brian Plato, DO, FAHS, talks about when healthcare professionals should be concerned about a secondary headache disorder

Brian Plato, DO, FAHS, is the medical director of headache medicine at Norton Neuroscience Institute in Louisville, Kentucky. He recently discussed red flags in headache history providers need to look for that may indicate worsening health issues. Watch the full interview from the 2018 Scottsdale Headache Symposium here:

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Plato says changes in headache—or sudden onset of a new headache type—should concern medical professionals. 

“As a provider, I’m concerned when a patient who has had a stable history of headache has a sudden change in the features,” he says. “This may be in terms of where it hurts or how it hurts, sudden onset headache or other associated neurological or systemic symptoms.”

Plato says that changes in—or the development of—other associated symptoms are red flags in a patient’s headache history. He says most patients seeking medical attention for headache have a diagnosis of migraine. Many times, he’s looking for symptoms that are not migrainous in nature. These symptoms can include fever, weight loss, significant vision changes, weakness, numbness, and trouble speaking or concentrating. These indicators may mean there’s another condition besides a primary headache disorder in play. Other features, such as a sudden onset headache, should also be flagged if they were not part of a patient’s headache history before.

If a clinician sees a patient who begins to present with some of these red flags, Plato says they should refer the patient for further investigation. This may include imaging of the brain and the blood vessels supplying the brain. For physicians who are not headache specialists, Plato recommends referring patients to someone within that specialty.

“If a patient presents with symptoms that are concerning to the clinician, I would encourage them to get in touch with someone in their community that might be more experienced with headache,” he says.

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