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Introduction Headaches comprise 8-14% of total presentations to acute services. Secondary headaches cause greater morbidity and mortality (1,2,3). A five-question tool previously showed utility in identifying secondary headache (1). We present a preliminary revalidation analysis with unilateral headache as an added feature.Methods A six-week retrospective review of headache patients attending neuro-SDEC at UCLH. Six parameters: thunderclap headache, focal neurological symptoms, focal neurological signs, systemic symptoms, unilateral headache, age greater than 50, were assessed. Multiple triggers of the tool were reviewed.Results 62 patients were included. 69% had primary headache & 31% had secondary headache. The tool positively identified 74% of secondary headache (sensitivity: 74%, specificity: 40%). With removal of the least specific question, focal symptoms, sensitivity was 69% & specificity 53%. Unilateral headache was not correlated to headache type. The most specific question was focal signs (specificity: 94%, accuracy: 76%). Multiple triggers improved specificity to 81%.Conclusion Focal symptoms had the least diagnostic utility with focal neurological signs the most. Unilateral headache had no additive effect. Multiple triggers improved specificity. Seasonal sinusitis prevalence may have contributed to secondary headache percentage. Further data collection to expand the cohort, correlation plot analysis, and modification for potential clinical use, is being undertaken.a.dethabrew@nhs.net