ReviewNeurology2019
Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list.
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In one paragraph
Review in Neurology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 125 papers, 7 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
125citing papers in PubMed, 7 pooled it
15.9field-weighted citation impact, top 1% of its field
What it found
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Who cites it
125 citing papers in PubMed, 7 syntheses or guidelines pooled it, 368 citations in OpenAlex.
- ESR Essentials: neuroimaging of pediatric headaches in the emergent and non-emergent setting-practice recommendations by the European Society of Neuroradiology.European radiology · 2026Guideline
- Approach to headache disorders and the management of migraine: consensus guidelines from the Headache Society of Singapore, first edition (2023).Singapore medical journal · 2026Guideline
- Chiropractic Management of Adults with Cervicogenic or Tension-Type Headaches: Development of a Clinical Practice Guideline.Journal of integrative and complementary medicine · 2026Pooled it
- Migraine-like headaches: a systematic review of secondary etiologies, clinical features and therapeutic patterns (1977-2024).The journal of headache and pain · 2025Pooled it
- A clinical guide for physiotherapists to assess and manage cervical musculoskeletal impairment and pain sensitivity in migraine patients.The Journal of manual & manipulative therapy · 2025Guideline
- Biomarkers in headaches as a potential solution to simplify differential diagnosis of primary headache disorders: a systematic review.The journal of headache and pain · 2025Pooled it
- Pooled it
- Soluble guanylate cyclase induces cranial vasodilation and headache in adults: a randomized trial.Brain communications · 2025Trial
- Preliminary accuracy, inter- and intra-rater reliability of a 4-point cervical artery dissection diagnostic decision support tool in an ambulatory setting using real and simulated cases: a quality improvement project.Chiropractic & manual therapies · 2026Article
- Orchestrator multi-agent clinical decision support system for secondary headache diagnosis in primary care.Journal of the American Medical Informatics Association : JAMIA · 2026Article
- Migraine 1-2-3-4-5: a candidate communication aid for adult migraine without aura.The journal of headache and pain · 2026Article
- Association between spinal manipulative therapy and cervical artery dissection in patients with neck pain or headache: a retrospective cohort study.Chiropractic & manual therapies · 2026Article
- Manchester Triage System: Effectiveness, Limitations, and Global Implementation-A Structured Narrative Review.Healthcare (Basel, Switzerland) · 2026Review
- RapidNeuroGuide: an NLP-enhanced AI platform for digital headache triage and clinical decision support.BMC emergency medicine · 2026Article
- Migraine in Young Stroke Patients-Better Outcomes Despite Distinct Risk Profiles: Insights From the STROKE-CARD-Study.European journal of neurology · 2026Observational
- Diagnostic Performance of Mobile Low-Field MRI and CT for Acute Headache as the Isolated Clinical Manifestation in the Neurology Emergency Department.CNS neuroscience & therapeutics · 2026Article
- [Development and validation of Cefalytics: an artificial intelligence-based application for the rapid diagnosis of primary headaches].Atencion primaria · 2026Article
- Just the facts: cluster headache and other side-locked headaches in the emergency department.CJEM · 2026Article
- Clinical characteristics of perimenopausal migraine and its correlation to hormonal levels.The journal of headache and pain · 2026Article
- Pediatric migraine: Neurodevelopmental mechanisms, clinical phenotypes, and modern therapeutics.World journal of clinical pediatrics · 2026Review
65 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 1 institution in 6 countries.
Thien Phu DoFrom the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland.ORCID 0000-0002-9631-0665
Angelique RemmersFrom the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland.
Henrik Winther SchytzFrom the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland.
Christoph SchankinFrom the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland.
Sarah E NelsonFrom the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland.
Mark ObermannFrom the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland.
Jakob Møller HansenFrom the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland.
Alexandra J SinclairFrom the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland.
Andreas R GantenbeinFrom the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland.
Guus G SchoonmanFrom the Headache Diagnostic Laboratory (T.P.D., H.W.S.), Danish Headache Center and Department of Neurology (J.M.H.), Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark; Department of Neurology (A.R., G.G.S.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland; Department of Neurology and Anesthesiology/Critical Care Medicine (S.E.N.), Johns Hopkins University, Baltimore, MD; Center for Neurology (M.O.), Asklepios Hospitals Schildautal, Seesen; Department of Neurology (M.O.), University Hospital Essen, University of Duisburg-Essen, Germany; Neurometabolism (A.J.S.), Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, UK; and Neurorehabilitation (A.R.G.), RehaClinic Bad Zurzach and University of Zürich, Switzerland. g.schoonman@etz.nl.
University of Bern · CH
Funding
Department of Health NIHR-CS-011-028Medical Research Council MR/K015184/1
Abstract
A minority of headache patients have a secondary headache disorder. The medical literature presents and promotes red flags to increase the likelihood of identifying a secondary etiology. In this review, we aim to discuss the incidence and prevalence of secondary headaches as well as the data on sensitivity, specificity, and predictive value of red flags for secondary headaches. We review the following red flags: (1) systemic symptoms including fever; (2) neoplasm history; (3) neurologic deficit (including decreased consciousness); (4) sudden or abrupt onset; (5) older age (onset after 65 years); (6) pattern change or recent onset of new headache; (7) positional headache; (8) precipitated by sneezing, coughing, or exercise; (9) papilledema; (10) progressive headache and atypical presentations; (11) pregnancy or puerperium; (12) painful eye with autonomic features; (13) posttraumatic onset of headache; (14) pathology of the immune system such as HIV; (15) painkiller overuse or new drug at onset of headache. Using the systematic SNNOOP10 list to screen new headache patients will presumably increase the likelihood of detecting a secondary cause. The lack of prospective epidemiologic studies on red flags and the low incidence of many secondary headaches leave many questions unanswered and call for large prospective studies. A validated screening tool could reduce unneeded neuroimaging and costs.
Indexed as
AgedAged, 80 and overFemaleHeadacheHumansMaleNeoplasmsNervous System DiseasesNeuroimaging
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