Review of Paediatric Headache Referrals to a Regional Centre

Background: Headaches are a common reason for referral to paediatric clinics. We reviewed the type of headache referrals received with the aim of using this information to triage more effectively and better use available resources to lead to better patient outcomes.

Methods: We undertook a retrospective chart review of all patients referred with a primary headache over a six-month period from January to June 2016.

Results: Thirty-five patients with a mean age of 10.1years(3-15.7yrs) were referred over the six-month period, 18/35 to the neurology service. Nine patients were referred with red flag symptoms including nocturnal or early morning headaches, vomiting or progressive worsening in headaches. The presence or absence of red flag features was omitted in 12 referrals. Relevant family history was included in 17% of referrals. Clinical exam details were absent in 26% of referrals. On average patients waited 124.2 days for their appointment. Those with red flag symptoms waited on average 108.6 days. Twelve patients(34%) were referred for imaging and 9/10 MRIs performed were normal. (34%). One patient was found to have two incidental ependymal cysts in the right lateral ventricle. Of the patients with a headache variant diagnosis, classical migraine was the most common at 45%, followed by tension headache at 28%. Lifestyle modification was the most common advice, prophylaxis included Riboflavin and Pizotifen and acute treatment with triptans.

Conclusion: Low patient referral numbers may be accounted for by patients accessing services through the emergency department or the Paediatric Assessment Unit. As referral information was often suboptimal, we aim to introduce a template for referral for primary care colleagues in order to correctly identify patients in most need of rapid access to paediatric services.