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.
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.