Direct to an emergency department for:

  • Headache with:
    • sudden onset or thunderclap headache
    • severe headache with signs of systemic illness (fever, neck stiffness, vomiting, confusion, drowsiness, dehydration)
    • severe disabling headache
    • severe headache associated with recent head trauma
  • Headache suggesting temporal artheritis (focal neurological symptoms, altered vision, elevated erythrocyte sedimentation rate and C-reactive protein in patients > 50 years of age).

Criteria for referral to public hospital specialist clinic services

  • 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).

Information to be included in the referral

Information that must be provided

  • Onset, characteristics and frequency of headache
  • Current and complete medication history (including non-prescription medicines, herbs and supplements)
  • Any medicines previously tried, duration of trial and effect
  • Erythrocyte sedimentation rate and C-reactive protein for patient > 50 years, or if giant cell arteritis or vasculitis suspected
  • Details of any previous neurology assessments or opinions.

Provide if available

  • Neuroimaging results
  • If symptoms are thought to be linked to probable or confirmed SARS CoV-2 (COVID-19) infection or Long COVID.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

  • Mild or tension headache
  • Untreated typical migraine
  • Isolated migraine in patients with an established diagnosis
  • Chronic migraine already being managed by a neurologist.