UMEM Educational Pearls

Category: Neurology

Title: SNOOP for Headache Red Flags

Keywords: secondary headache, features, risk factors, red flags (PubMed Search)

Posted: 7/10/2019 by WanTsu Wendy Chang, MD
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  • Symptoms/signs that suggest serious underlying conditions causing headaches are summarized by the mnemonic SNOOP:
    • Systemic symptoms/signs/disease
      • e.g. fever, weight loss, HIV, malignancy, pregnancy
    • Neurologic symptoms/signs
      • e.g. altered mental status, diplopia, pulsatile tinnitus, loss of consciousness
    • Onset sudden, abrupt, thunderclap
      • i.e. pain reaches maximal intensity instantly after onset
    • Older age of onset, especially > 50 years
    • 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.


  • 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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