This Headache page was reviewed and updated in July 2018 taking into account the new evidence of Sodium Valproate and Pregnancy – Please see Drug Safety Update
Headache is one of the commonest reasons for referrals to neurology. Before making a referral for headache, please consult the text below for advice on management, and when, how and whether referral is required.
For Headache where there is a suspicion of brain cancer/tumour (e.g. cognitive changes, Cancer/HIV, focal signs, LOC..etc), please refer to this page Radiology> Headache Suspicious of Cancer
M. A & R.D 12-10-22
Referral to Neurology for chronic headache – local guidance
5 questions to consider before referral:
- CT head? Do you want a clinical opinion or a CT head scan? – if just the latter then NHS Lothian provides open access CT head. Remember, incidental finding (10%) vs. relevant finding (<0.5%), radiation dose is over 100 chest x-rays and studies suggest it doesn’t provide long-lasting reassurance
- Acute Treatments for Migraine (see below links for more detail) – have you tried soluble Aspirin 900mg, Sumatriptan 100mg, Almotriptan 12.5mg, rizatriptan 10mg with anti-emetics? If severe vomiting, try subcutaneous Sumatriptan 6mg.
- Preventative Treatment for migraine (see below links for more detail) – have you tried a Beta-blocker (eg Propanolol), Antiepileptic (Topiramate) or Tricyclic (eg Amitriptyline) at therapeutic doses for 3-4 months each.
- Treatment of Medication Overuse Headache – Stop regular analgesia (especially codeine) and limit acute treatment to 10x/month. Tell the patient they will feel worse for a while and wait for 3-4 weeks before expecting any benefit
- Tackle insomnia and fatigue – Many patients with chronic daily headache also have insomnia and fatigue. Improving other causes of these symptoms can improve headache.+
Pathway Information
- Headache as a new complaint including adult assessment
- Guide to differentiating primary headache disorders
Referral to Neurology
Referral via the ‘Chronic Headache’ pathway on SCI gateway is appropriate for patients who have tried all of the treatments above including preventative medication for a period of 3 months each at therapeutic doses
www.neurodiagnosis.org website has been put together by Neurologists from the Department of Clinical Neurosciences, Western General Hospital, Edinburgh. The purpose of the website is to provide better information to patients and GPs about common ‘orphan’ neurological conditions which may not be well represented by patient organisations and which may be hard to get clear information on.
