Red flags

Initially refer chronic headache to Neurology especially if red flags are present. Pain management referral should be considered only after assessment by a Neurologist. Undiagnosed headaches should always be referred to Neurology if not responding to management in primary care.

Consider emergency referral of patients with any of the following:

  • Thunderclap headache
  • Severe headache with signs of systemic illness e.g. fever
  • First ever headache with focal signs especially persisting over 1 hr (still present)
  • Sudden onset first severe headache (persisting)
  • Severe headache associated with recent head trauma (last 12 hours)

Features that may lead to Neurology Category 1 categorisation

  • Age over 50 with new severe headache
  • Tender temporal arteries
  • Headache associated with transient visual loss
  • Sudden onset first severe headache
  • Progressively worsening headache
  • New onset in immunocompromised patient (refer to emergency if systemic illness also present)
  • Headache with focal neurological signs excluding typical migraine aura
  • Associated papilloedema

Features that may lead to more urgent PPMS categorisation

  • Severe symptoms despite optimum management
  • Escalating opioid dependency

Other important information for referring practitioners

Try to categorise headache.

Lifestyle changes

  • Optimise sleep
  • Reduce stress
  • Consider psychology referral for:
    • Any associated mood disorder
    • Pain management
  • Advise exercise and healthy nutrition
  • Ensure adequate hydration

Medical management

  • Diagnose source of pain and nature of condition
  • Consider treatment of associated conditions
    • Stress/anxiety/depression – refer psychologist
    • MS
  • Check medication list for side effects involving headache
  • Develop strategies to avoid medication overuse

Referral requirements

A referral may be rejected without the following information.

  • Persistent Pain Management Service eReferral form
  • Reason for referral
    • Diagnosis
    • Comprehensive management plan
    • Multidisciplinary team approach
  • Medical history
    • Primary headache should be able to be diagnosed on history alone
    • Include a timeline since onset of symptoms
    • Include letters from neurology or other pain specialists
    • Workcover/medicolegal information and status if work related
  • Examination
    • Only include relevant examination findings
  • Management to date, including treatments trialled
  • Current medications and past medications trialled for pain
  • List drug dependencies, inappropriate drug use and prescribed drug misuse e.g. nicotine, alcohol, cannabis, opioids
  • Allergies
  • Relevant examination findings
  • Investigations (useful only to exclude or confirm causes of secondary headache)
    • FBC, E/LFTs, ESR, CRP
    • Neuroimaging (CT/MRI)

Additional referral information (useful for processing the referral)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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