To determine the predictive factors for serious causes of non-traumatic headache (NTH).

A retrospective analysis of medical records was conducted for emergency room patients with NTH from May to November 2022. Patients were classified into serious and non-serious headache groups, which were compared based on baseline characteristics, associated symptoms and physical examination findings. Regression analysis identified predictive factors for serious NTH causes.

Out of 7,059 patients, 518 met the inclusion criteria, of which, 47 (9.0%) were diagnosed with a serious headache cause. The factors with a significant predictive value were male sex (odds ratio (OR) 0.36, 95% confidence interval (CI) 0.17-0.75, p=0.01), age >50 years (OR 4.94, 95% CI: 2.28-10.71, p=<0.01), duration of headache >1 week (OR 0.24, 95% CI: 0.01-0.59. p=0.01), seizures (OR 10.57, 95% CI: 1.22-9131, p=<0.03), meningism (OR 50.4, 95% CI: 2.98-853.66, p=<0.01) and neurological deficits, including cranial nerve palsy (OR 5.64, 95% CI: 1.30-24.44, p=<0.21), hemiparesis/plegy (OR 7.13, 95% CI: 2.17-23.48, p=<0.01) and altered consciousness (OR 9.88, 95% CI: 2.93-33.3, p=<0.00).

The risk factors predictive of serious headache causes align with commonly recognized red flags. Their varying predictive values could form the basis for a risk stratification tool that enhances the accuracy of health workers’ triage of headache patients in the emergency department.