Headaches – red flags and orange flags

Red flags

Probability of underlying tumour >1%. Investigate urgently.

  • Focal neurology
  • Significant alterations in consciousness
  • Memory loss or confusion
  • Co-ordination problems
  • Seizures
  • Known cancer

Orange flags

Probability of underlying tumour: 0.1 – 1%. Monitor carefully and have low threshold for investigation. However, if continue with no change in signs/symptoms for >12 weeks, rarely due to tumour.

  • New headache with no diagnostic pattern after 8 weeks.
  • Abnormal findings on neurological examination, or other neurological symptoms. Doesn’t that count as ‘focal neurology’? I’m confused.
  • Headache aggravated by exertion/Valsalva manoeuvre
  • Headaches associated with vomiting (wouldn’t this include most migraines?)
  • Significant change in longstanding headache problem – esp. rapid increase in frequency
  • New-onset headache in patient >50 yrs
  • Headaches that wake from sleep

(Pulse on-line learning module)


About Dr Sarah

I'm a GP with a husband and two young children.
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