Headache or migraine Referral Access Criteria

• 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 (1-2 days) head trauma/or if on anticoagulants.
• Headaches with papilledema or focal neurological signs
• >50 years with raised CRP/ESR with suspected temporal arteritis

• Severe/acute trigeminal neuralgia with inability to eat
• Abnormal neurological exam with concerning features, including malignancy on neuroimaging (new onset headache)
• Idiopathic intracranial hypertension

• Chronic headache with concerning clinical signs
• Concerning features on neuroimaging (excluding age appropriate deep white matter)
• Severe frequent migraine impacting on daily activities (e.g. work, study, school or carer role) despite prophylactic treatment
• Chronic or atypical headache unresponsive to medical management (e.g. cluster headache, trigeminal neuralgia, medication overuse headache).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Relevant history, onset and duration of symptoms including:
  
  • Evolution of symptoms – progressive, stable or improving
• Degree of functional impairment (e.g. impact on mobility/falls/employment/ADLs/weight loss/carer information)
• Details of previous treatment and outcome including acute and preventative treatments trialled

• BMI or estimate
• Physical examination including any focal neurological signs

• For patients >50 years:
  
  • ESR
  • CRP         

• Indicate whether the patient has previously attended a neurology clinic or seen a neurologist, or any other specialist doctor (eg geriatrician, rheumatologist, spinal/orthopaedic surgeon or general physician)
  
  • If so please attach contact details, dates and any other information and correspondence relating to these visits.      

• Nil

• Copy of neuroimaging results
• Fundoscopy findings

Category 1

Appointment within 30 days

•  No defined category 1 criteria

Category 2

Appointment within 90 days

• Severe frequent headaches and trial of at least 3 migraine preventive medications or appropriate treatments based on headache phenotype without improvement (list 3 treatments trialled) 

Category 3

Appointment within 365 days

• Chronic/complicated headache/migraine unresponsive to medical management

• Chronic headache where standard treatment has not been tried
  
  • Consider trialling conservative / standard treatment
  • See Clinician Assist WA: Headaches in Adults (external site)

• Nil