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Updates in the Diagnostic Approach of Headache

  • Secondary Headache (M Robbins, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In this review, we summarize updates in the diagnostic approach of headaches with the aim of facilitating the distinction between primary and secondary etiology in headaches.

Recent Findings

In the USA, headache is the fifth most common complaint in the emergency department, but only a minority will have a secondary etiology. Initial suspicion and diagnostic workup of secondary headache relies on a patient’s medical history due to a scarcity of validated biomarkers. A special interest group under the International Headache Society recently synthesized information on red flags (information that indicates a secondary etiology) and green flags (information that indicates a primary etiology). A systematic diagnostic approach using red flags and green flags can help reduce unnecessary testing and shift attention to patient care.

Summary

Going forward, further validation of these concepts is needed to properly introduce them for clinical use.

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Abbreviations

CT:

Computerized tomography

ICHD:

International Classification of Headache Disorders

MRI:

Magnetic resonance imaging

SNNOOP10:

A mnemonic covering 15 red flags in headache

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Author information

Authors and Affiliations

  1. Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Thien Phu Do, Nikolaj Folke la Cour Karottki & Messoud Ashina

  2. Danish Knowledge Center On Headache Disorders, Glostrup, Denmark

    Messoud Ashina

  3. Department of Nervous Diseases of the Institute of Professional Education, IM Sechenov First Moscow State Medical University, Moscow, Russia

    Messoud Ashina

  4. Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan

    Messoud Ashina

Authors
  1. Thien Phu Do
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  2. Nikolaj Folke la Cour Karottki
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  3. Messoud Ashina
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Contributions

Thien Phu Do and Messoud Ashina contributed to the conception and design of the work. Thien Phu Do and Nikolaj Folke la Cour Karottki contributed to the acquisition of data for the work. Thien Phu Do, Nikolaj Folke la Cour Karottki, and Messoud Ashina contributed to the analysis of data for the work. Thien Phu Do, Nikolaj Folke la Cour Karottki, and Messoud Ashina contributed to the interpretation of data for the work. Thien Phu Do wrote the first draft of the manuscript. All the authors contributed to the critical revision of the work for important intellectual content. The authors read and approved the final manuscript.

Corresponding author

Correspondence to Messoud Ashina.

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Conflict of Interest

Messoud Ashina has received personal fees from AbbVie/Allergan, Amgen, Eli Lilly, Lundbeck, Novartis and Teva Pharmaceuticals. He is the principal investigator for ongoing clinical trials for AbbVie/Allergan, Amgen, and Lundbeck. He has received research grants from Lundbeck Foundation, Novo Nordisk Foundation, and Novartis. He serves as associate editor of Cephalalgia, The Journal of Headache and Pain, and Brain. He is the current President of the International Headache Society. Thien Phu Do and Nikolaj Folke la Cour Karottki report no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Secondary Headache

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Do, T.P., la Cour Karottki, N.F. & Ashina, M. Updates in the Diagnostic Approach of Headache. Curr Pain Headache Rep 25, 80 (2021). https://doi.org/10.1007/s11916-021-00995-8

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  • DOI: https://doi.org/10.1007/s11916-021-00995-8

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