Migraine Warning Signs: When Your Headache Is More Than Just Migraine

Migraine is the most common neurological disorder in the world, affecting over 150 million Indians. But the ubiquity of migraine creates a dangerous reassurance bias — patients and even doctors dismiss serious headaches as "just migraine" when they should be evaluated urgently. The ability to distinguish migraine from dangerous headache is one of the most important clinical skills in neurology. The SNOOP mnemonic captures the red flags that should always prompt further investigation.

Red Flags — The SNOOP Mnemonic

S — Systemic features: Headache with fever, weight loss, or symptoms of systemic illness suggests infection (meningitis, brain abscess) or malignancy. Any headache with fever and neck stiffness requires urgent LP to exclude meningitis. N — Neurological signs: New neurological symptoms accompanying the headache — focal weakness, sensory disturbance, speech difficulty, visual field loss — suggest stroke, tumour, or AVM. The aura of migraine is short-lived (20–60 minutes) and reverses completely; persistent neurological deficits are not migraine aura. O — Onset (thunderclap): A headache that reaches maximum intensity within 60 seconds of onset — the "worst headache of my life" — is a subarachnoid haemorrhage until proven otherwise. Emergency CT head and LP are mandatory. O — Older age of onset: A first severe headache above age 50 should not be attributed to primary migraine without investigation — this age group is more likely to have secondary headache from tumour, giant cell arteritis, or subdural haematoma. P — Progressive: A headache that is worsening progressively over weeks suggests raised intracranial pressure from tumour, hydrocephalus, or chronic subdural haematoma. Positional worsening (worse lying flat, worse bending forward) is particularly concerning.

The Pattern That Is Migraine

Recurrent attacks over months to years; same character each time; associated with nausea, photophobia, phonophobia; triggered by known personal triggers; unilateral (though bilateral migraine exists); relieved by sleep and dark environment; family history; responds to triptans. Any headache that deviates significantly from this established personal pattern requires reassessment. Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.