FIRST OR WORST HEADACHE
The question “Is this your first or worst headache?” addresses the issue of new-onset headache and the age at which it becomes a concern. Of the two headache classes, primary disorders are more common. These disorders can occur at any age but most often begin during childhood or between 20 and 50 years of age.6 Onset of headache after 50 years of age is a red flag for consideration of a secondary headache disorder such as temporal arteritis or a mass lesion(Table 4).6
Careful attention to and thoughtful consideration of neuroimaging and/or cerebrospinal fluid (CSF) analysis are mandatory when a patient of any age complains of a first or worst headache.7–9 If the patient routinely has headaches, it is important to determine whether the current episode is typical.