Headache

Availability

North South North West Statewide

Pre-referral work-up

History

All referrals should comply with referral standards.

In particular:

  • Onset
  • Severity
  • Duration
  • Pattern

Also the:

  • Family history
  • Current medications and medications trialled
  • History of trauma/travel
  • Past history especially of malignancy or recent systemic symptoms
  • Impact on life/work

Tests

Tests to consider:

  • ESR
  • FBE
  • UEC
  • BSL
  • CT Brain

Interim/GP management

To refer a patient with this condition, please see the Neurology clinic page for the full referral process and templates.

  • Consider asking patient to keep a headache diary to record frequency, duration, relieving and aggravating factors.
  • In patients with frequent migraine consider trailling a migraine prophylactic drug such as amitriptyline or propranolol prior to review at an adequate dose.
  • Avoid opiates (including tramadol and codeine) for management of headache due to the potential to develop medication overuse headache.

Direct link to Health Pathways - Headache page

For more information please see the Tasmanian Health Pathways website.

Emergency

Thunderclap onset/very sudden severe onset

  • Consider SAH, pituitary apoplexy, haemorrhage into mass lesion

Signs and Symptoms of meningoencephalitis

  • Fever, neck flexion stiffness, rash

First headache with focal neurological signs or symptoms (consider stroke)

Urgent / category 1

Older person (>50 years) with systemic symptoms and high ESR -  consider temporal arteritis

Signs or symptoms of raised intracranial pressure such as papilloedema

New onset in patient with immunosuppression or malignancy (consider meningitis, abcess or metastasis)

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

International Headache Society

Headache Australia

Cluster Headache Australia

Headache Diary Template

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED
– Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED
– Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED
– Phone: (03) 6493 6340 Fax: (03) 6464 1926
RHH ED
– Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

We will endeavour to see these patients within two weeks.

Urgent referrals should be accompanied by a phone call, as per below:

  • Contact the Neurology Registrar directly within hours via the RHH switchboard Phone: (03) 6166 8308
Semi-urgent:
Routine:

Next available appointment