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Date revised 12/23/03
Educational and Patient Care Protocols 1
Chapter 2 - 5
Headache Algorithm
Patient with complaint ofheadache
Presence ofheadache red
flags (A)
Primary headache is likely
Posterior headache with possible anterior
projection and neck pain, aggravated by neckmotions or sustained
neck posture and
physical and radiographic evidence of cervicalspine
involvement?
One of the following is
present?:- nausea, vomiting- photo/phono phobia
Two of the following are present?:- pulsating, moderate- severe
intensity, aggravated by routine activities
Recurrent, unilateral severeheadache of short duration
> 15 attacks per month for atleast 6 months, and nausea,
or photo or phono phobia
Are prodomalsymptomspresent?
Migraine without aura.
Proceed tomanagement protocols
Migraine with aura.Proceed to
management protocols
Cluster headache.Proceed to
management
protocols
Cervicogenic
headache.Proceed to
managementprotocols
Chronic tension
headache.Proceed to management
protocols
Episodic tensionheadache.
Proceed to managementprotocols
Pressing, tightening non-pulsating, mild ormoderate, bilateral,
not aggravated by physical
activity?
Rule out
secondarycauses ofheadache
Proceed to
Algorithm 2
Yes
Yes
No
Yes
No
Primary Headache Algorithm(Submitted by Levittown Health Center
Headache Working Group)
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Historical / ExaminationRed Flags (A)
1. Headache of recentorigin (< 6 months)
2. A recent increase in thefrequency and/or severity of
the headache experience
3. Presence of CNS and/orcranial nerve abnormalities
4. Trauma
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Date revised 12/23/03
Educational and Patient Care Protocols 2
Chapter 2 - 5
Headache Algorithm Page 2
Possible secondary
headache
Atypical primary
headache. Proceed tomanagement protocol
Post-traumatic
syndrome (includes
tension-type and
migraine presentations)
Return to primary HA
algorithm
Chronic subdural
hematoma. Refer for
neurologic consultation
Tumor.
Refer for neurologicconsultation
Acute glaucoma. Refer for
ophthalmic consultation
Temporal arteritis. Refe r to
primary care physician for
management
Elderly patient
(trauma may betrivial or not
recalled)
History of head
trauma
CN and/or CNS
(including
mental status)
abnormalities
Blurred visionand pain around
eye?
Temporal artery
tender, thickened,
granular quality,
elevated ESR
Yes
Yes
No
Yes
No
YesYes
No
No
No
No
Nuchalrigidity
FeverYes
Meningitis. Immediate
referral to Emergency
Department
Subarachnoid hemorrhage.
Immediate referral to
Emergency Department
No
Yes
Secondary Headache Algorithm
