What clinical feature would suggest an intracranial neoplasm rather than a primary headache disorder?

The identification of a progressive headache over time is a key clinical feature that indicates the possibility of an intracranial neoplasm rather than a primary headache disorder. When a patient describes headaches that are not only consistent but also increasingly severe or frequent, this persistence and intensity can suggest an underlying pathology, such as a tumor, that may be causing increased intracranial pressure or direct irritation of neural structures.

In primary headache disorders, such as tension-type headaches or migraines, headaches may have episodic patterns and are often managed effectively with analgesics or specific treatments. Unlike primary headache disorders, which may be stable or improve with treatment, a progressive pattern typically raises concern for more serious underlying issues that warrant further investigation, like imaging studies.

Other features of headaches may still occur in both primary headache disorders and intracranial neoplasms, but the growing severity and frequency of headache in cases of suspected neoplasms differentiate them from more benign conditions. Thus, the progressive nature of the headache serves as a critical red flag that needs to be evaluated further.