• Symptoms/signs that suggest serious underlying conditions causing headaches are summarized by the mnemonic SNOOP:
  • S - Systemic symptoms/signs/disease
    • e.g. fever, weight loss, HIV, malignancy, pregnancy
  • N - Neurologic symptoms/signs
    • e.g. altered mental status, diplopia, pulsatile tinnitus, loss of consciousness
  • O - Onset sudden, abrupt, thunderclap
    • i.e. pain reaches maximal intensity instantly after onset
  • O - Older age of onset, especially > 50 years
  • P - Pattern change
    • e.g. change in frequency, severity, clinical features, precipitated by Valsalva, aggravated by postural change
• Consider structural pathologies, vascular disorders, infectious and inflammatory conditions in the evaluation of secondary headache syndromes.

References

• Chou DE. Secondary headache syndromes. Continuum (Minneap Minn) 2018;24(4, Headache):1179-91.
• Doric DW. Pearls: headache. Semin Neurol 2010;30(1):74-81.

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