Introduction: Headache is one of the most universal medical symptoms and reasons for neurological consultation. The study was designed to evaluate the patients presenting with headache with Red flag signs and to analyze the cause by neuroimaging

Material and Methods: This study was observational study of 100 patients designed to evaluate the patients presenting with headache with Red flag signs and to analyze the cause of by neuroimaging .All patients with headache with red flag signs and who underwent Neuroimaging were included in study.

Observation: Female preponderance was noted, with female to male ratio of 1.5:1. Most of the patients belong to age group of 41-60 years. 62% of the patients presenting with red flag signs had significant neuroimaging findings .Most common cause of secondary headache in patients with red flag signs was found to be haemorrhage followed by Tubercular meningitis .Abnormal neurological examination and headache associated with fever /neck stiffness have statistically significant correlation with abnormal neuroimaging.

Conclusion: Red Flag Signs are considered as an important tool for the need of neuroimaging in patients presenting with secondary headache. Of all the Red Flag signs “Headache associated with abnormal neurological examination” and “headache associated with neck stiffness/fever” have the most significant association with abnormal neuroimaging although other red flag signs are equally valuable.

Keywords: Headache, red flag signs ,neuroimaging, haemorrhage ,thunderclap headache ,meningitis , neck stiffness.

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