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Headache or migraine

Headache or migraine

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region:

  • Sudden onset/thunderclap headache
  • Severe headache with signs of systemic illness (fever, neck stiffness, vomiting, confusion, drowsiness)
  • First severe headache age >50 years
  • Severe headache associated with recent (1-2 days) head trauma or if on anticoagulants
  • Headaches with papilledema or focal neurological signs
  • >50 years with raised CRP/ESR with suspected temporal arteritis 

Immediately contact on-call registrar or service to arrange an immediate neurology assessment (seen within 7 days) for:

  • Severe/acute trigeminal neuralgia with inability to eat
  • Abnormal neurological exam with concerning features, including malignancy on neuroimaging (new onset headache)
  • Idiopathic intracranial hypertension

To contact the relevant service, please see HealthPathways: Acute Neurology Assessment

Presenting issues
  • Chronic headache with concerning clinical signs
  • Concerning features on neuroimaging (excluding age appropriate deep white matter)
  • Severe frequent migraine impacting on daily activities (e.g. work, study, school or carer role) despite prophylactic treatment
  • Chronic or atypical headache unresponsive to medical management (e.g. cluster headache, trigeminal neuralgia, medication overuse headache). 
Mandatory referral information (referral will be returned if this information is not included)

History

  • Relevant history, onset and duration of symptoms including:
    • Evolution of symptoms - progressive, stable or improving
  • Degree of functional impairment (e.g. impact on mobility/falls/employment/ADLs/weight loss/carer information)
  • Details of previous treatment and outcome including acute and preventative treatments trialled

Examination

  • BMI or estimate
  • Physical examination including any focal neurological signs

Investigations

  • For patients > 50 years:
    • ESR
    • CRP

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due geographical location or financial cost)
Highly desirable referral information
  • Copy of neuroimaging results
  • Fundoscopy findings
  • Indicate whether the patient has previously attended a neurology clinic or seen a neurologist, or any other specialist doctor (e.g. geriatrician, rheumatologist, spinal/orthopaedic surgeon or general physician)
    • If so please attach contact details, dates and any other information and correspondence relating to these visits. 
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • No defined category 1 criteria
Category 2
Appointment within 90 days
  • Severe frequent headaches and trial of at least 3 migraine preventive medications or appropriate treatments based on headache phenotype without improvement (list 3 treatments trialled)
Category 3
Appointment within 365 days
  • Chronic/complicated headache/migraine unresponsive to medical management
Excluded neurology services

Referral to public adult neurology outpatient services is not routinely accepted for the following conditions:

Condition Details (where applicable)
Chronic headache where standard treatment has not been tried
Last reviewed: 29-06-2023
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