Headache

Referrals pathways for Regional Paediatric model

Index:

Practice points

Referral pathways

Headache is an extremely common childhood presentation.

For the diagnosis and management of headache, please refer to the Royal Children’s Hospital clinical practice guidelines.

Practice Points

• It is important to distinguish more concerning headache from the common chronic causes of headache such as:
  • migraine - intermittent severe often unilateral pain +/- associated nausea & photophobia
  • tension headache - frequent, often daily, commonly late in day with few associated symptoms
• The pattern of headaches often gives the biggest clue to the diagnosis.
• Migraines and tension headaches generally do not require neuroimaging.
• Neuroimaging for headaches must weigh up the significant radiation dose when using CT.
• Red flags for headaches that warrant further investigation and/or referral include:
  • progressive
  • acute severe
  • focal neurology
  • early morning headache or vomiting
  • age < 3 years old
  • hypertension

Referral pathways

• Paediatrician
  • Most headaches can be adequately managed in the general practice setting. For further information regarding management of migraine and tension headaches see the Kids Health Info site.
  • Referral to paediatric outpatient services can be considered in the assessment and management of headaches when red flags are present, or if other measures have failed.
    • Information to bring to any appointments:
      • headache diary, including severity
      • any investigations performed previously
      • any reports from other health professionals.
  • Sudden onset acute severe headaches or those with associated neurological change require referral to Emergency Department or consultation with paediatric services.
• Neurologist
  • Referral to neurology services can be considered after consultation with general paediatric services.
• Psychologist
  • Referral to mental health services is an important adjunct to medical modalities in the management of chronic headache, particularly for tension headaches.
• Other therapies
  • Alternate therapies for chronic headaches, particularly tension headaches, include acupuncture, relaxation therapies, aromatherapy, etc.