Headache red-flag and disposition workflow

Point-of-care workflow to distinguish high-risk headache presentations from structured outpatient management.

Medium-risk workflowLast reviewed September 4, 2026

AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.

Scope

Use for

Initial adult headache assessment, secondary-cause screening, and outpatient management of a likely primary headache.

Not for

Establish time to peak intensity, first/new versus recurrent pattern, exertional/positional triggers, trauma, pregnancy/postpartum status, cancer/immunosuppression, and medication-use days.
Check temperature, blood pressure, mental status, focused neurologic/eye examination, and neck findings; assess for papilledema when feasible.

Treat these as urgent. Escalate early if concern persists or follow-up is unreliable.

Emergency assessment for thunderclap onset, focal deficit, seizure, altered consciousness, fever/meningismus, papilledema, or a painful red eye with visual impairment.
New severe headache in pregnancy/postpartum needs urgent secondary-cause assessment, especially with hypertension or neurologic/visual symptoms.
New onset after age 50, jaw claudication/visual symptoms, cancer/immunosuppression, or a progressive/exertional/positional pattern requires targeted urgent assessment; suspected giant cell arteritis with visual symptoms is an emergency.

Avoid routine imaging for a typical episodic migraine with normal examination and no secondary-cause warning signs; absence of a focal deficit alone is insufficient.
Choose acute treatment for the diagnosed headache type after contraindication review; avoid opioids as first-line migraine treatment.
Use a headache/medication diary. Medication-overuse risk rises at 10 days/month for triptans/opioids/combination analgesics and 15 days/month for acetaminophen/NSAIDs.

Review treatment response, attack frequency, disability, and medication days; consider preventive management for frequent/disabling attacks.
Give emergency precautions for thunderclap onset, new neurologic/visual findings, fever/neck stiffness, or deterioration; reassess any changing pattern.

Return precautions you can say as written:

“If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.”

Point to the red flags above that apply to this patient.
Confirm follow-up timing and where to go after hours.
Attach a relevant handout to reinforce the plan.
Document disposition, rationale, unresolved uncertainty, and that precautions were understood.

Clinical owner: Family Medicine Editorial Team
Risk tier: Medium
Review cadence: Every 6 months
Last reviewed: September 4, 2026AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.
Review status: Evidence current. Next review due March 4, 2027.