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It is common for individuals with headaches and migraines to be referred for additional investigations like blood tests or for scans such as MRIs, CT’s, and X-Rays. This is done to screen for any sinister conditions or diseases. In addition to head pain, people may experience other symptoms that serve as warning signs of sinister conditions – these are known as ‘Red flags’


Keep reading to find out more about normal headache symptoms vs. headache red flags!

Primary vs Secondary Headaches

Primary headaches are those which have an unknown cause. It can occur as a result of the following: brain tumors, brain or spinal cord injuries, aneurysms, and meningitis. Primary headaches often occur with warning signs or ‘red flags’ that you should watch out for. However, these can sometimes be difficult to identify as symptoms of primary headaches can overlap with normal symptoms seen in secondary headaches.

A secondary headache is one in which the cause of the symptoms is known. Some examples of secondary headaches are migraines, cluster headaches, and tension-type headaches. At the Brisbane Headache and Migraine clinics, we aim to find and address the root cause of secondary headaches.

Below is a list of some of the red flags found in primary headaches. Keep reading to find out more!

Headache Red Flags

Red flags are signs or symptoms that may be associated with a disease or condition that could be potentially severe. If any red flags are identified, these require immediate medical investigation.

If one or more of the following headache red flags resonate with you or someone you know, please seek medical advice from your doctor.



General headache red flags

  • Abrupt onset of unusual or severe headaches (e.g., thunderclap headaches)
  • New onset of headaches in those over 50 years old
  • Dramatic or unusual change in a longstanding headache
  • The onset of a headache for the first time during a pregnancy.
  • Headaches associated with sneezing, coughing, going to the toilet, or physical exertion.
  • Weakness, loss of muscle strength, or reduced coordination
  • Altered speech or impaired comprehension, memory loss
  • Rapid, unintentional changes in weight
  • Tremors or seizures
  • Headaches associated with systemic illnesses (e.g., flu, fevers)
  • Unexplained vomiting
  • Changes in bowel or bladder function and/or numbness in the saddle region

Early morning headache red flags

  • Headache that worsens with position changes (e.g., sitting/standing upright or laying down in bed).
  • Waking up during the night or in the morning with severe or new headaches

Pediatric headache red flags

  • Headaches associated with a history of craniocervical instability
    • Cranio-cervical instability occurs due to weakness or laxity of the ligaments around the base of your skull, this is common in children with conditions like Down Syndrome.
  • Genetic or congenital conditions that affect the integrity of connective tissue (muscles, tendons, and ligaments).
    • For example, conditions such as Ehlers-Danlos syndrome.
  • Genetic or congenital conditions that affect the integrity of the bones
    • For example, conditions such as os odontoideum or osteogenesis imperfecta


More vs Less Severe Types of Headache

As previously mentioned, primary and secondary headaches can often share similar symptoms, therefore, it can sometimes be difficult to identify a true headache red flag. Below are some points that you can use to help you identify whether the above symptoms may be a true red flag.

  • Headaches that have been stable (unchanging) for 3+ months are thought to be less severe. If you have had a new and/or unusual headache develop, this may indicate the need for further medical investigation.
  • If you have had any history of injury or trauma to the neck, it is advised to have this assessed through further medical investigation.
  • If you have started getting headaches following any severe viral or bacterial infections, it is recommended to seek a further medical investigation.
  • Headaches that alternate between the left and right sides of the head are thought to be less severe as these typically result from musculoskeletal impairment. However, some individuals have stable headaches that DON’T alternate between left and right sides or occur on BOTH sides of the head. If you’re unsure or would like more information, make sure you chat with your doctor about your symptoms.



Pre-existing or Hereditary Conditions that Affects Headaches

  • Headaches with an associated history of vascular disease (e.g., stroke, aneurysm),
  • Headaches with an associated history of cancer (particularly lung cancer, breast cancer, or melanomas).
  • History of autoimmune or inflammatory conditions
  • History of neurological conditions (e.g., multiple sclerosis, epilepsy)
  • Connective tissue disorders (e.g., Ehlers-Danlos syndrome)
  • Genetic conditions such as Down Syndrome or Chiari Malformations


When to See a Headache Expert

If you or someone you know experience any of the above symptoms OR you would like further information, please ensure that you seek medical advice from your doctor first. If you identify with many of the above signs and symptoms, it is strongly recommended to seek immediate investigation to determine the cause of the condition.

Contact the Migraine experts today

If you have been suffering from headaches or migraines and your symptoms do not relate to those listed above, call our clinic to book in and speak with our experienced team! Our clinicians have had vast training in treating headache and migraine conditions and even in identifying any potential red flags. Call in today to start your journey to a headache and migraine-free life!