Which red flag symptoms in a patient with headaches should prompt immediate investigation for a brain tumour?

For adults, loss of central neurological function (progressive, sub-acute) should prompt consideration of an urgent, direct access MRI scan of the brain (or CT scan if MRI is contraindicated) to be done within 2 weeks, for suspected brain or central nervous system cancer ⁴.

For children and young people, newly abnormal cerebellar or other central neurological function should prompt consideration of a very urgent referral for specialist assessment within 48 hours for suspected brain or central nervous system cancer ⁴.

Additionally, for patients presenting with headache, the following features should prompt evaluation and consideration for further investigations and/or referral, as they may indicate a serious underlying cause including a brain tumour:

• New-onset neurological deficit ².
• New-onset cognitive dysfunction ².
• Change in personality ².
• Impaired level of consciousness ².
• Vomiting without other obvious cause ².
• Headache triggered by cough, Valsalva manoeuvre, or sneeze ².
• Headache triggered by exercise ².
• Orthostatic headache (headache that changes with posture) ².
• A substantial change in the characteristics of their headache ².
• New-onset headache with compromised immunity (e.g., caused by HIV or immunosuppressive drugs) ².
• Age under 20 years with a history of malignancy ².
• A history of malignancy known to metastasise to the brain ².