Headache referral checklist

Urgency tier

• Thunderclap onset or worst headache of life.
• New headache after age 50 or with cancer/immunosuppression.
• Focal neurologic deficits, altered mental status, or seizure.
• Fever, neck stiffness, or signs of infection.
• Papilledema or progressive neurologic symptoms.

Minimum pre-referral workup

• Headache history including onset, duration, frequency, and triggers.
• Focused neurologic exam and vital signs, including blood pressure.
• Medication and caffeine use, including overuse of analgesics.
• Pregnancy test when appropriate.
• Review of prior imaging or emergency visits.

Referral packet checklist

• Headache phenotype (migraine, tension, cluster) and disability impact.
• Frequency, duration, and response to acute or preventive therapy.
• Neurologic exam findings and any abnormal vitals.
• Prior imaging results and dates if performed.
• Relevant comorbidities and medication list.

Pre-referral optimization tasks

• Limit acute analgesic overuse and document safe dose limits.
• Start or adjust first-line symptom plan while awaiting referral where appropriate.
• Reinforce return precautions for sudden severe headache or new neurologic deficits.

References

• Choosing Wisely Canada Headache (opens in a new tab)

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