Loading...

Headache

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:

  1. 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
  2. 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.
  3. 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, see Migraine/Chronic Headache – RefHelp
  4. 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
  5. 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

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