Headache red-flag triage
Structured headache approach emphasizing secondary-cause red flags and safe outpatient follow-up boundaries.
Last reviewed February 7, 2026
Red flags
- Thunderclap onset or worst headache of life.
- Focal neurologic deficits, altered mental status, seizure, or papilledema concern.
- Fever with meningeal signs, new severe headache in immunocompromised patients, or progressive neurologic decline.
Assessment priorities
- Characterize onset, severity, pattern change, and associated neurologic symptoms.
- Review medication overuse, sleep, hydration, and blood pressure contributors.
- Screen for infection, pregnancy, trauma, and vascular risk context.
Initial management
- Classify likely primary headache only after red-flag screening is negative.
- Use conservative symptomatic management and avoid low-value imaging where no red flags exist.
- Provide clear explanation of uncertainty and planned reassessment interval.
Follow-up and escalation
- Reassess if headache pattern evolves or fails to improve as expected.
- Escalate urgently for new neurologic signs, severe refractory symptoms, or systemic instability.
- Coordinate specialist referral when diagnostic uncertainty or complexity persists.
References
- Choosing Wisely Canada Headache (opens in a new tab)
- Government of Canada Migraine overview (opens in a new tab)
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