Typically, headaches are divided into two categories: primary and secondary. Primary headaches, such as tension headaches or migraines, are usually caused by overactivity in the pain-sensitive structure of the brain.

Secondary headaches can usually be linked to other causes, such as an underlying health condition, stroke, brain tumour, toxic exposure, or changes in brain pressure. The side effects of medication can also trigger secondary headaches.

With around 80 to 90 per cent of headaches being primary, it is essential to understand and recognise the red flags of secondary headaches. Catching issues such as a blood clot or brain tumour early can help prevent the condition from becoming worse and more problematic for the patient to have treated.

What are secondary headache red flags?

Identifying secondary headaches as early as possible will give the patient a better health outcome. Healthcare providers can use the mnemonic “SNOOP4” to remember and better recall the red flags of secondary headaches. SNOOP4 breaks down as follows:

• Systemic Signs: ‘S’ refers to systemic symptoms, such as night sweats, fever or other symptoms of a systemic process. It also refers to systemic illness, such as a patient with a secondary medical condition or is immunocompromised.

• Neurological Symptoms: ‘N’ stands for neurological and healthcare providers should conduct a neurological exam to look for signs that point to a secondary headache. Most patients with a primary headache don’t typically have neurological symptoms. Signs to look for include new numbness, visual changes and physical weakness in one arm or leg.

• Onset is Sudden: ‘O’ stands for a sudden onset headache. Often described as a thunderclap headache, this can be one of the most concerning issues with a secondary headache. The sudden onset headache can be rated ten out of ten for intensity and can indicate the patient has a vascular issue, such as an aneurysm, which should be assessed ASAP.

• Older Age at Onset: The second ‘O’ refers to a patient experiencing a new onset headache over 50. Older-aged patients are more likely to have a secondary cause or illness.

• ‘P4’ covers four conditions: (1) Progression: Secondary headaches tend to progress and become much more severe or intense more frequently. Primary headaches tend to be more sporadic and will fluctuate over time. (2) Papilledema: This is swelling of the optic nerve. This can be picked up through a fundoscopic exam, indicating increased pressure in and around the brain. (3) Positional or Precipitated by Valsalva: This is where a headache changes in intensity in different positions, such as when going from standing to lying, or is triggered by the Valsalva manoeuvre (coughing or straining). These signs could point to a pressure issue, or a problem related to some type of mass. (4) Pregnancy: New-onset headaches during or following pregnancy are concerning and should be evaluated for secondary conditions.

PDUK provides a range of professional medical training courses and practical hands-on workshops for healthcare staff such as junior doctors, nurses, primary-care practitioners, and allied healthcare workers. We highly recommend the following three-day online course for healthcare providers in primary care settings tasked with managing minor illnesses..

A13 Minor ailments essentials: Online

The RCN Centre has accredited this three-day online minor illness course for Professional Accreditation until the 24th of April 2024. The course has been designed for healthcare practitioners already confident in taking a patient history and physical examination and wanting to focus on the common and not-so-common complaints seen in primary health care.

The course has been designed for participants to gain up-to-date knowledge and boost skills and self-confidence in assessing and treating patients in a primary-care setting. This course is aimed at nurse practitioners, practice nurses, non-medical prescribers, pharmacists, paramedics, and other allied health professionals.

Upon course completion, participants will:

• Have more confidence in taking safe, targeted histories for a variety of patient presentations.
• Be more able to assess and identify various common conditions.
• Have reviewed appropriate additional diagnostics required for accurate patient assessment.
• Have discussed patient management, including referral requirements for safe practice

The course runs for three days from 10:00 am- 4:30 pm, and all course material, evaluations and certificates are provided.