July 15, 2010

The Red Flag of Headache

Red flag means emergency and require further evaluation including CT Scan.

1) Acute onset of first most severe headache ever in life.

2) Headache that is increase in frequency or intensity

3) New onset of headache after age of 50 years old

4) Present of mental state changes

5) Associated with fever, neck stiffness and vomiting

6) Presence of neurological deficit

7) Headache with evidence of increase ICP

Extra notes

1) Most of the headache are primary headache

2) Patient with Subarachnoid hemorrhage may explain the headache as acute onset, most severe headache in their life, thunder clap around occipital area.

3) Primary headache can be safely manage with NSAIDs

4) Brain cell do not have pain receptor. Headache usually cause by stretching of pain receptor in blood vessel either due to direct insult or increase ICP.

5) Although first line of treatment for migraine is 5HT3 antagonist or triptans group, patient can be managed with IV NSAIDs + IV Maxalon.

6) Hypertension rarely cause headache unless the diastolic blood pressure more than 120 mmHg.


  1. Salam alaik.

    Yup, there's no strong evidence linking hypertension and headache. Perhaps unless very severe, that is. I read about this in emedicine commentary article few months back.

    But the weird thing is that many people still ask about headache when trying to diagnose simple hypertension. Simple BP measurements are the most practical way to assess control of BP.

    I like your blog. Keep sharing, thanks.


  2. bro zuhairi:

    yup betul tu.. infact, sometime anti hypertensive agent sendiri bleh sebabkan headache. contohnya ialah captopril. sebab tu bila nak start 1st dose captopril ialah kita advise pt utk take it before sleep.

    talking about BP, berdasarkan pengalaman cetek saya. we really have to be extra careful with BP measurement esp bab2 cuff dia.

    pernah i encounter one pt bila check automatic NIBP, can not read. then bla buat manual, mmg hypertensive crisis.

    but tu sebab cuff terlampau nipis. then bila change into appropriate cuff, it just moderate HPT shj..

    so dangerous...

    and yup. sometime, headache is important in a very severe hypertension..



Ya Allah! Permudahkanlah aku untuk menuntut ilmuMu, memahaminya, mengingati dan menyebarkannya. Berkatilah ilmu itu dan tambahkanlah ia. Amin.