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.+
