Title: SNOOP for Headache Red Flags<br/>Author: WanTsu Wendy Chang<br/><a href='http://umem.org/profiles/faculty/1322/'>[Click to email author]</a><hr/><h3 style="color:#bba504;font-size:16px;font-weight:normal;font-family:verdana,arial,helvetica,sans-serif;">    </h3>  <ul style="caret-color: rgb(0, 0, 0); color: rgb(0, 0, 0); font-family: -webkit-standard;">   <li>    <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Symptoms/signs that suggest serious underlying conditions causing headaches are summarized by the mnemonic SNOOP:</span></span>    <ul>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="color:#ff0000;"><b>S </b></span>- <b><u>S</u></b>ystemic symptoms/signs/disease</span></span>      <ul>       <li>        <em><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">e.g. fever, weight loss, HIV, malignancy, pregnancy</span></span></em></li>      </ul>     </li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="color:#ff0000;"><b>N </b></span>- <b><u>N</u></b>eurologic symptoms/signs </span></span>      <ul>       <li>        <em><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">e.g. altered mental status, diplopia, pulsatile tinnitus, loss of consciousness</span></span></em></li>      </ul>     </li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="color:#ff0000;"><b>O </b></span>- <b><u>O</u></b>nset sudden, abrupt, thunderclap </span></span>      <ul>       <li>        <em><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">i.e. pain reaches maximal intensity instantly after onset</span></span></em></li>      </ul>     </li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="color:#ff0000;"><b>O </b></span>- <b><u>O</u></b>lder age of onset, especially > 50 years</span></span></li>     <li>      <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><span style="color:#ff0000;"><b>P </b></span>- <b><u>P</u></b>attern change </span></span>      <ul>       <li>        <em><span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">e.g. change in frequency, severity, clinical features, precipitated by Valsalva, aggravated by postural change</span></span></em></li>      </ul>     </li>    </ul>   </li>   <li>    <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Consider structural pathologies, vascular disorders, infectious and inflammatory conditions in the evaluation of secondary headache syndromes.</span></span></li>  </ul>  <fieldset><legend>References</legend>

                <ul style="caret-color: rgb(0, 0, 0); color: rgb(0, 0, 0); font-family: -webkit-standard;">   <li>    <span style="font-size: 14px;"><span style="font-family: arial, helvetica, sans-serif;">Chou DE. Secondary headache syndromes. <i>Continuum (Minneap Minn) </i>2018;24(4, Headache):1179-91.</span></span></li>   <li>    <span style="font-size: 14px;"><span style="font-family: arial, helvetica, sans-serif;">Doric DW. Pearls: headache. <i>Semin Neurol </i>2010;30(1):74-81.</span></span></li>  </ul>  <p style="text-align: center;">   <em><strong><span style="font-size: 14px;"><span style="font-family: arial, helvetica, sans-serif;">Follow me on Twitter @EM_NCC</span></span></strong></em></p>  </fieldset>