Headache - Royal North Shore Hospital

We provide initial assessment and up to 3 visits regarding treatment for:

· Patients with Primary Headache Disorders i.e. Migraine, Trigeminal Autonomic Cephalalgias, Medication Overuse Headache, who have trialled and failed at least one prophylactic agent with their GP

· Relevant images (including CT or MRI scan of the brain) if they have been performed

· List of current medications and drug allergies, a list of previously trialled migraine prophylactic medications

· Your referral letter from your GP/Specialist

Your GP or non-GP specialist is always your first step in seeking treatment for any condition. You will be referred to our service if your treating doctor feels that your treatment requires the input of a neurologist. Once we receive the referral it will be reviewed by a doctor and you will be notified of the outcome and next steps. Please allow at least 4 weeks for this process to be undertaken. We see patients either face to face or via telehealth – our team will let you know what the best option is for you. Please note that we cannot accept all patients referred to our clinic. Consider an appointment with a private neurologist in your area.

Please note that phone calls from the hospital will appear as a blocked number.

If you have a scheduled appointment you will receive a reminder text message.

Please allow a full afternoon for your appointment. Some patients require a longer review and delays can occur.

Indications for referral for clinic appointment

· Migraine:

Ø Recurrent and difficult to treat migraine: requirement are previous trials of triptan (if not contraindicated) and at least one prophylactic medication

Ø New migraine without aura: requirement is recent eye check

Ø New migraine with aura: requirement are MRI brain (bring report and CD to appointment) AND recent eye check

· Cluster headache or other trigeminal autonomic neuralgias (TACs)

· Medication and caffeine overuse headache

Indications for urgent referral to local Emergency Department

· New acute onset headache disorders requiring urgent inpatient investigations and management, such as suspected intracranial haemorrhage, trauma, meningitis, raised intracranial pressure.

Patients with acute secondary headache should be immediately referred to the Emergency Department:

“Red flags” for this include ((Ref: adapted from eTG 2018 headache guidelines)

· Sudden onset

· First ever headache with focal neurological signs, confusion or drowsiness

· Patient with new headache older than 50 years

· Onset after head trauma

· Progressive frequency and severity over weeks to months (refractory to treatments)

· New onset of systemic illness (e.g. fever, rash, neck flexion stiffness)

· Papilloedema

· Positional headache

Exclusion criteria

· Residents from outside NSLHD

· 2nd opinion or patients who have seen a neurologist previously

· Patients requiring Botox therapy – please note that we are unable to provide this service in our clinic

· Secondary headache (see list above “the following conditions should be immediately referred to the Emergency Department”)

· Tension headache

· Patients with unclear finding on brain imaging

· Aneurysm follow up or post-surgical pain (refer back to surgical team)

Out of NSLHD · Residents from outside NSLHD will generally not be considered for our clinic, only in rare circumstances e.g. continuing the care of existing condition already managed by NSLHD

The following information must be included for referral to be accepted:

· Symptoms, previous investigations, previous treatments

Providing more information will aid the triage process and make it more likely that your patient will be seen in the most timely manner possible.

Please submit referrals using the eReferral system through HealthLink, which can be accessed through most clinical software systems.

Alternatively, address letters to Dr Miriam Priglinger or other specialist listed below

Email: [email protected]

Referrals will be triaged and your patient will be notified of the outcome as soon as possible. This process may take between 1-4 weeks. You will be contacted if more information is needed. Telehealth services are available, please indicate on the referral if you feel this would be suitable for your patient’s appointment.

Your Team

Dr Bronwyn Jenkins

Dr Miriam Priglinger

Please see the website of the the Australian and New Zealand Headache Society https://anzheadachesociety.org/ for relevant information about lifestyle management for headache and useful resources like headache diary.