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McGeeney BE - Many disorders herald their onset or presence with headache. Of particular concern are those disorders that do not present with signs and symptoms that quickly point to an underlying etiology, and may present with headache as a first or sole symptom. New headache has a very wide differential, as opposed to chronic recurrent headache. Early identification of secondary headache is made easier by identifying those at higher risk of secondary headache, based on their background along with features of the presentation, such as new onset headache, thunderclap onset headache, and headache presentations in those over 50 years old. Other examples include those with HIV and other immunocompromised states, and a history of cancer. Such patients need more rigorous evaluation.

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