Are there worrisome features (SNOOP)?10
 Systemic symptoms or illness (especially fever, change in mentation, anticoagulation, current or recent pregnancy, or cancer)
 Neurologic symptoms or signs (papilledema, asymmetric cranial nerve or motor function, or abnormal cerebellar function)
 Onset is recent or sudden
 Onset after 40 years of age
 Previous headache history is different or progressive
What is the primary headache type? (Determine original headache pattern and any changes over time)
 Duration longer than four hours
 Migraine features: chronic (transformed) migraine
 Lacking migraine features: chronic tension-type headache
 Abrupt onset headache pattern: new daily persistent headache
 Strictly unilateral: hemicrania continua
 Duration shorter than four hours
 Strictly unilateral/autonomic features: indomethacin-responsive headaches
 Unilateral or bilateral/no associated autonomic features
Evidence of medication overuse (including nonprescription drugs and caffeine)
Evidence for underlying physical factors
 Myofascial factors
 Cervical
 Temporomandibular
 Fibromyalgia
 Other chronic pain
 Sinus symptoms
 Sleep disturbance
Evidence for psychiatric comorbidity
 Depressive disorders
 Anxiety disorders
 Chemical dependency
 Personality disorders