Headache is one of the most common symptoms encountered in clinical practice. In most cases, it is benign—associated with migraine, stress, sleep deprivation, or a common cold—and can often be managed with simple analgesics such as paracetamol or ibuprofen.
However, not all headaches are harmless! Certain warning signs, or “red flags,” may point toward a serious underlying pathology and warrant urgent evaluation and further investigation.
Red Flag Signs in Headache
- Fever with neck stiffness
This combination should immediately raise suspicion of meningitis or other central nervous system infections. - History of malignancy (cancer)
may be an indication of brain metastasis- cancer cells may have travelling from its primary site to reach the brain! - Thunderclap headache
A sudden, severe headache reaching peak intensity within seconds to minutes. It is a characteristic of bleeding into the subarachnoid layer of brain. - Positional headache
Headache that worsens on lying down or improves on standing may suggest raised intracranial pressure. - Post-traumatic headache
Headache following head injury could indicate intracranial bleeding and warrants further investigation as soon as possible. - History of hypertension
Severe headache in a hypertensive patient may be a sign of hypertensive emergency - New-onset headache in the elderly
new onset Headache after the age of 50 should always be evaluated carefully with suspician of arteritis( inflammation of arteries) - Associated neurological signs and symptoms
Symptoms such as confusion, altered consciousness, visual disturbances, focal weakness, seizures, or abnormal movements strongly suggest central nervous system involvement.
When it comes to headaches, always ask: Is this just pain—or a warning sign?
MBH/PS