When a headache is cause for concern

Q: How can you tell when a headache requires additional diagnostic testing?

A: Headaches come with a wide range of accompanying symptoms and severity. Most often, they are due to a primary headache disorder such as a tension-type headache or migraine. In older adults, the majority of headaches are still primary in nature.

However, older adults are more likely than their younger counterparts to experience a secondary headache disorder. A secondary headache is when the headache pain is a symptom of an underlying problem or condition. An ice cream headache is an example of a secondary headache that isn’t a worrisome cause. However, some secondary headaches may be warning signs of something more serious, such as an aneurysm or tumor.

Certain “red flag” characteristics are more worrisome. Represented by the acronym SNOOP4, these headache characteristics include:

• Systemic symptoms — Accompanied by fever, chills, night sweats or unintentional weight loss.
• Neurologic symptoms — Accompanied by signs and symptoms such as weakness, numbness, trouble walking, confusion, seizures, or difficulty staying alert or maintaining consciousness.
• Onset — Begins suddenly or abruptly, such as a severe headache that peaks within one to two minutes (thunderclap headache).
• Older age — Begins to occur or progress after age 50.
• Pattern change — Changes in frequency, severity or character that’s different from any previously experienced headaches. For example, if you normally have mild visual symptoms with your headaches, a dramatic increase in visual symptoms may be concerning.
• Progressive — Attacks that worsen over time.
• Precipitated by exertion — Occurs with a cough, sexual activity, bowel movements, bearing down, or other activity.
• Positional worsening — Changes in severity depending on whether you’re upright or lying down.

Talk to your doctor if you’re having new headaches or headaches that seem out of the ordinary for you. If a severe headache comes on suddenly, seek emergency medical attention.

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