Patient selection: nontraumatic headache in the ED, apparently adults
Red flag signs used clinically:
(1) age > 50 years
(2) abrupt or sudden onset
(3) positional provocation
(4) fever, weight loss or other systemic findings
(5) HIV, malignancy or other risk factor for secondary headache
(6) altered level of consciousness or focal neurological deficit
(7) papilledema
Parameters for clinical prediction rule:
(1) onset
(2) awakening pain (pain present when the patient awakens)
(3) duration in weeks
(4) fever
(5) worse headache ever
(6) level of consciousness
(7) localizing neurological deficit
|
Parameter
|
Finding
|
Points
|
|
onset
|
abrupt
|
1
|
|
|
not abrupt
|
0
|
|
awakening pain
|
absent
|
0
|
|
|
present
|
1
|
|
duration
|
<= 1 week
|
0
|
|
|
> 1 week
|
1
|
|
fever
|
absent
|
0
|
|
|
present
|
1
|
|
worse headache ever
|
no
|
0
|
|
|
yes
|
2
|
|
consciousness
|
normal
|
0
|
|
|
altered
|
3
|
|
localizing neurologic deficit
|
absent
|
0
|
|
|
present
|
1
|
total score =
= SUM(points for all of the paramters)
Interpretation:
• minimum score: 0
• maximum score: 10
• A score >= 3 was associated with a serious intracranial cause.
Performance:
• The area under the ROC curve is 0.93.
