Episode 39: Red Flag Warning Signs in Headache
April 2nd, 2015
In this episode Dr. Jeptha Davenport provides the definition of migraine, the meaning of ‘primary’ and ‘secondary’ headaches, and a list of ‘red flag’ features to recognize life-threatening headaches. Migraine is the most common sort of headache for which patients seek medical treatment, Jeptha reviews it briefly, in order to contrast the warning signs, which would not be expected in migraine or other primary headaches. Knowing when a headache may be life-threatening is an important skill for all physicians to develop. Migraine and the most commons sorts of headaches (tension-type) certainly may be disabling but are not life-threatening. Distinguishing these common headaches from an ominous headache may be based either on recognizing the headache type or recognizing worrisome features. Worrisome features depend on who has the headache, what other conditions the patient has, particular symptoms and particular signs.
Jeptha gives us a list of 15 features to help identify potentially life-threatening headaches. He suggests to group them into 4 types of features: 1) characteristics of the patient or history, 2) features of the headache itself, 3) additional symptoms, and 4) signs not expected in primary headaches. When ‘red flag’ features are identified, further consultation and/or investigation is suggested.
Finally, Jeptha describes the consequences of when a ‘red flag headache’ is not recognized, and highlights the need of appropriate training for physicians. A physician who can recognize the ‘red flag’ features of secondary headache will be better equipped to help patients with headaches of all kinds and will feel confident in providing the best care possible for headache sufferers.
After listening to this podcast listeners will be able to:
Name the most common types of headache brought to medical attention
Discuss reasons to correctly identify different types of headaches
List ‘red flag features’ of headache in 4 large groups
Feel confident in planning management of ‘red flag’ headaches (including referral)
Wm. Jeptha Davenport MD, FRCPC (Neurology), DABPN
Email: jeptha.davenport@albertahealthservices.ca | Phone: 403-956-2460
Dr. Davenport graduated from the University of Illinois with a bachelor’s degree in philosophy and neurosciences. He obtained his medical degree from the University of Illinois as well, and moved on to complete his neurology residency at McGill University in Montreal. Dr. Davenport then completed a post-doctoral research fellowship in the area of neurophysiology and pain in the Department of Physiology at the University of Toronto, before entering practice as a general adult neurologist. He joined the Cumming School of Medicine at the University of Calgary in 2008.
References:
World Health Organization. Atlas of headache disorders and resources in the world 2011. Geneva: WHO Press, 2011. 35 pp. http://www.who.int/mental_health/management/who_atlas_headache_disorders.pdf?ua=1 (accessed February 9, 2015)
Headache Classification Committee of the International Headache Society (IHS).The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. doi: 10.1177/0333102413485658.
Choosing Wisely Canada: Imaging tests for headaches: When you need them – and when you don’t. http://www.choosingwiselycanada.org/materials/imaging-tests-for-headaches-when-you-need-them-and-when-you-dont/ (accessed February 9, 2015)