American Board of Internal Medicine (ABIM) Certification Practice Exam

What is NOT a red flag for secondary headache disorders?

1. New headache in a previously healthy adult

2. Neurologic symptoms lasting greater than 1 hour

3. Headache that progressively worsens

4. New headache in patients with cancer

The correct answer is: New headache in a previously healthy adult

A new headache in a previously healthy adult is not automatically classified as a red flag for secondary headache disorders. While any new headache in adults, particularly if it represents a different pattern than their usual headaches, should be evaluated with consideration of possible secondary causes, the mere fact that it is new and the patient is otherwise healthy does not make it a definitive red flag. Red flags for secondary headaches typically include clinical features that suggest the headache might be caused by an underlying serious condition such as a tumor, hemorrhage, or infection. A new headache in a previously healthy adult might warrant further investigation, but it does not necessarily indicate a more serious pathology without additional concerning signs. In contrast, neurologic symptoms lasting greater than one hour could indicate a potential issue such as a transient ischemic attack or other serious neurologic conditions, making it a red flag. A headache that progressively worsens is also concerning, as it can suggest a growing mass or other underlying pathology, increasing the likelihood of a secondary headache disorder. Similarly, a new headache in patients with cancer is particularly concerning, as it raises the possibility of metastases or other cancer-related complications, which is why it is considered a red flag as well.