Headaches

Emergency department referrals

All urgent cases must be discussed with the on-call Registrar to obtain appropriate prioritisation and treatment. Contact through:

Caboolture Hospital (07) 5433 8888
Redcliffe Hospital (07) 3883 7777
Royal Brisbane and Women's Hospital (07) 3646 8111

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Headaches that wake the patient at night or headaches immediately on wakening
New and severe headaches
Headaches associated with significant persisting change of personality or cognitive ability or deterioration in school performance or delay in development
Recent head injury or head trauma
Any abnormalities on neurological examination, such as: focal weakness, gait disturbance, papilledema, diplopia, visual disturbance.
Sudden onset headache reaching maximum intensity within 5 minutes (= explosive onset)
Presence of an intracranial Cerebral Spinal Fluid (CSF) shunt
Hypertension above 95^th centile by age for systolic or diastolic

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

History of malignancy, recent head trauma
Age < 6 years
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.

Category 2

Appointment within 90 days is desirable

Headaches with initial onset within 3 months of referral
Missing significant amounts of school due to headaches

Category 3

Appointment within 365 days is desirable

Chronic headaches that have previously been assessed by a specialist

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

Refer to HealthPathways for assessment and management information if available
Neuroimaging is not usually recommended when the neurological examination is normal. MRI is a more appropriate investigation than CT if imaging is required
Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC.
In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services: Department of Children, Youth Justice and Multicultural Affairs

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and Examination

Detailed history of headaches
- how long has the patient been getting headaches?
- what is their frequency and duration?
BP (right arm, with appropriately sized cuff)
Report presence or absence of concerning features
- Change in mood, mental status, or school performance since the onset of the headaches
- Headaches usually present on waking or wake the child in the early morning
Confirmation of OOHC (where appropriate)

Additional referral information (useful for processing the referral)

Highly desirable information – may change triage category

Exacerbating and relieving factors
Reason for presentation at this time
Details of previous specialist assessment
Burden of disease:
- are there associated symptoms (vomiting, behaviour change)?
- is the child missing school? How many days missed in the last month?
- is the headache affecting sleep?
- other information to assess the burden of the symptom

Desirable Information- will assist at consultation.

Other past medical history
Immunisation history
Developmental history
Medication history
Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Youth Justice and Multicultural Affairs 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

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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