Headaches/migraine
PAEDIATRIC
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Emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.
Adult
Stroke/transient ischaemic attack (TIA)
- Patient with acute neurological symptoms of a stroke; multiple/crescendo TIA
- New acute symptoms
Progressive loss of neurological function
- Acute onset severe:
- ataxia
- vertigo
- visual loss
- Acute severe exacerbation of known MS
Seizures/epilepsy
- Status epilepticus/epilepsy with concerning features:
- first seizure
- focal deficit post-ictally
- seizure associated with recent trauma
- persistent severe headache > 1 hour post-ictally
- seizure with fever
Headache/migraine
- Headache with concerning features:
- sudden onset/thunderclap headache
- severe headache with signs of systemic illness (fever, neck stiffness, vomiting, confusion, drowsiness)
- first severe headache age > 50 years
- severe headache associated with recent head trauma
- recent onset headaches in young obese females
- papilledema
- >50 years with raised CRP/ESR or if giant cell arteritis or vasculitis suspected
Movement disorders
- Ocular
Other referrals to emergency
- Altered level of consciousness
- Bilateral limb weakness with or without bladder and/or bowel dysfunction
- Acute rapidly progressive weakness (Guillain-Barre Syndrome, myelopathy)
- Delirium/sudden onset confusion with or without fever
Paediatric
Seizures/epilepsy
Headaches/migraine
Functional neurological symptoms
- The patient is unable to mobilize safely or has frequent falls/seizure like attacksAddition
Movement disorder
Hypotonic infant
Gait abnormality, isolated motor delay or focal weakness
Stroke
Other neurological conditions
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Other useful information for referring practitioners Not and exhaustive list
Minimum Referral Criteria
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Category 1
(appointment within 30 calendar days)- Recurrent hemiplegic migraine
- A child currently in out of home care (OOHC), or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service.
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Category 2
(appointment within 90 calendar days)- Idiopathic intracranial hypertension referred by a Paediatrician where there is diagnostic uncertainty that headache is due to IIH, failure of response to treatment and no visual impairment on perimetry (no indication for urgent neurosurgical shunting).
- Migraine that has failed two (2) preventative medications
- Missing significant amounts of school due to headaches
- Suspicion of medication overuse
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Category 3
(appointment within 365 calendar days)- No category 3 criteria
Please insert the below information and minimum referral criteria into referral
1. Reason for request Indicate on the referral
- 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
2. Essential referral information Referral will be returned without this
- Detailed history of headaches
- how long has the patient been getting headaches?
- what is their frequency and duration?
- is the child missing school (how many days per month) or is normal daily activity limited?
- is there associated symptoms (vomiting, light/sound sensitivity)?
- BP (right arm, with appropriately sized cuff)
- Current medication history, efficacy (including over-the-counter preparations)
- Neurological examination including fundoscopy
- Confirmation of OOHC (where appropriate)
3. Additional referral information Useful for processing the referral
Highly desirable Information – may change triage category
- Exacerbating and relieving factors
- Reason for presentation currently
- Details of previous specialist assessment
- Headache diary
- If the child is in foster care, please provide the name and regional office for the Child Safety Officer who is the responsible case manager.
Desirable Information- will assist at consultation.
- Other past medical history
- Immunisation history
- Developmental history
- Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, department of child safety involvement)
- Height/weight/head circumference and growth charts with prior measurements if available.
- Other physical examination findings inclusive of CNS, birth marks or dysmorphology
- Any relevant laboratory results or medical imaging reports, urinalysis result
If neuroimaging has been done, arrange image transfer to PACS at the hospital the patient is being referred to, with the imaging reports. If electronic imaging transfer is not available, then a CD of the neuroimaging and report should be sent to the neurologist named in the referral.
4. Request
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General referral information
Patient's Demographic Details
- 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
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
Relevant clinical information about the condition
- 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
Reason for request
- 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
Clinical modifiers
- 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
Other relevant information
- 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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Notes
Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
Last updated: 21 June 2023
