Pohl Heiko, Do Thien Phu, García-Azorín David, Hansen Jakob Møller, Kristoffersen Espen Saxhaug, Nelson Sarah E, Obermann Mark, Sandor Peter S, Schankin Christoph J, Schytz Henrik Winther, Sinclair Alexandra, Schoonman Guus G, Gantenbein Andreas R
Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
The Danish Headache Center, Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark.
Headache. 2021 Feb;61(2):300-309. doi: 10.1111/head.14054. Epub 2021 Jan 6.
The aim of this study was to collect and rate Green Flags, that is, symptoms or pieces of information indicating that a patient is more likely to suffer from a primary than from a secondary headache.
When assessing headaches, a central question to be answered is whether the pain is primary or secondary to another disorder. To maximize the likelihood of a correct diagnosis, relevant signs and symptoms must be sought, identified, and weighed against each other.
The project was designed as a Delphi study. In the first round, an expert panel proposed green flags that were rated anonymously in two subsequent rounds. Proposals with an average rating of 4.0 and higher on a scale from 0 to 5 reached consensus.
Five Green Flags reached consensus: (i) "The current headache has already been present during childhood"; (ii) "The headache occurs in temporal relationship with the menstrual cycle"; (iii) "The patient has headache-free days"; (iv) "Close family members have the same headache phenotype"; and (v) "Headache occurred or stopped more than one week ago."
We propose five Green Flags for primary headache disorders. None being a pathognomonic sign, we recommend searching for both Green Flags and Red Flags. If both are present, a secondary headache should be suspected. Overall, the application of the Green Flag concept in clinical practice is likely to increase diagnostic accuracy and improve diagnostic resource allocation. Prospective studies in clinical populations should be conducted to validate these Green Flags.
本研究旨在收集并评估“绿旗”，即表明患者更有可能患原发性而非继发性头痛的症状或信息片段。
在评估头痛时，一个需要回答的核心问题是疼痛是原发性的还是继发于另一种疾病。为了最大限度地提高正确诊断的可能性，必须寻找、识别相关体征和症状，并相互权衡。
该项目设计为德尔菲研究。在第一轮中，一个专家小组提出了“绿旗”，并在随后的两轮中进行匿名评分。在0至5的评分量表上平均评分达到4.0及以上的提议达成了共识。
五个“绿旗”达成了共识：（i）“当前头痛在儿童期就已出现”；（ii）“头痛与月经周期存在时间关系”；（iii）“患者有无头痛的日子”；（iv）“近亲有相同的头痛表型”；以及（v）“头痛发生或停止超过一周前”。
我们提出了五个用于原发性头痛疾病的“绿旗”。由于没有一个是确诊体征，我们建议同时寻找“绿旗”和“红旗”。如果两者都存在，则应怀疑是继发性头痛。总体而言，在临床实践中应用“绿旗”概念可能会提高诊断准确性并改善诊断资源分配。应在临床人群中进行前瞻性研究以验证这些“绿旗”。
