Green Flags and headache: A concept study using the Delphi method

Abstract

Objective: The aim of this study was to collect and rate Green Flags, that is, symptoms or pieces of information indicating that a patient is more likely to suffer from a primary than from a secondary headache. Background: When assessing headaches, a central question to be answered is whether the pain is primary or secondary to another disorder. To maximize the likelihood of a correct diagnosis, relevant signs and symptoms must be sought, identified, and weighed against each other. Methods: The project was designed as a Delphi study. In the first round, an expert panel proposed green flags that were rated anonymously in two subsequent rounds. Proposals with an average rating of 4.0 and higher on a scale from 0 to 5 reached consensus. Results: Five Green Flags reached consensus: (i) "The current headache has already been present during childhood"; (ii) "The headache occurs in temporal relationship with the menstrual cycle"; (iii) "The patient has headache-free days"; (iv) "Close How to cite this article: Pohl H, Do TP, García-Azorín D, et al.

COVID-19 und Kopfschmerzen

“…Inzwischen werden Kopfschmerzen als ein auf eine COVID-19-Erkrankung hinweisendes Symptom interpretiert [29]. Da aber Kopfschmerzen auch bei Personen ohne Infektion häufig sind [8], ist der positiv prädiktive Wert dieses Symptoms alleine zu gering [30]. Eine begleitende Anosmie oder Ageusie deutet zwar mit hoher Sensitivität auf einen sekundären Kopfschmerz hin, trat aber nur bei rund einem Drittel aller Patientinnen und Patienten mit COVID-19-assoziierten Kopfschmerzen auf [11].…”

Barriers and gaps in headache education: a national cross-sectional survey of neurology residents in Denmark

“…The expectation is that residents would have a more consistent use and knowledge of diagnostic criteria over time due to accumulation of experience, but the pattern is similar for residents in the introduction program and the main program. With a limited number of training hours during residency, the low utilization of specific diagnostic criteria may be caused by a higher emphasis on stratification of cases into high-risk (secondary headache disorders, e.g., headache attributed to trauma) and low-risk patients (primary headache disorders, e.g., migraine) rather than specific diagnoses during early training [ 16 – 18 ]. This is not unreasonable as secondary headache disorders may cause significant morbidity, and for some etiologies, a relatively high mortality [ 17 ].…”

Practical use of non-steroidal anti-inflammatory drugs in relieving recurrent headaches

“…Одним из важнейших этапов диагностики формы ГБ у пациента является исключение симптоматических цефалгий, для чего используются различные практические подходы, в том числе концепция «красных флагов». Специальный анализ в рамках Delphi study позволил экспертам сформулировать принцип «зеленых флагов» в диагностике ГБ с благоприятным прогнозом (первичных ГБ) [10]. Признаки, указывающие на высокую вероятность первичной ГБ:…”

“…3) у пациента бывают дни без ГБ; 4) родственники имели/имеют подобный фенотип боли; 5) ГБ появилась или перестала беспокоить более недели назад [10].…”