Referral to emergency

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

  • haemodynamic instability
  • papilloedema
  • sudden onset (days) poor feeding/irritability
  • sudden onset decreased neurological function
  • suspected head injury post trauma
  • suspected meningitis
  • suspected raised intracranial pressure
  • thunderclap headache
  • concerning features of raised intracranial pressure may include:
    • headache worse in the morning
    • headache exacerbated by coughing, sneezing, straining, or bending forwards
    • papilledema
    • pulsatile tinnitus
    • visual symptoms – including transient reduction in vision with straining
  • in the case of suspected raised intracranial pressure but without any of the above features
    • arrange urgent ophthalmological examination to look for papilloedema
    • arrange urgent cerebral imaging to exclude space occupying lesion or cerebral venous sinus thrombosis
  • if features of raised intracranial pressure and abnormal cerebral imaging, refer to nearest emergency department

Please contact the paediatric medicine on-call registrar or relevant surgical or medical subspecialty to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Regional Health Networks 

Eyre and Far North Local Health Network

Flinders and Upper North Local Health Network

Limestone Coast Local Health Network

Exclusions

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • disabling migraine headaches despite trials of at least two first line migraine preventive medications
    • a third prophylactic agent and headache diary should be commenced while awaiting review
  • intracranial hypertension suspected
  • suspected overuse of medication
  • unresponsive to medication management without visual impairment
  • visual impairment

Category 2 (appointment clinically indicated within 90 days)

  • headache/migraine controlled with medications requiring specialist diagnosis or management

Category 3 (appointment clinically indicated within 365 days)

  • nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • past medical history, provide any relevant features as relating triage categories
  • current medication list including medications and treatments used to date
  • family history of neurological disorders
  • presenting symptoms including
  • onset, frequency and duration of headaches
  • pain description including location, quality
  • functional impairment
  • associated features
    • vomiting, early morning/wakes the child from sleep, triggered or aggravated by coughing, sneezing or positional changes (bending forwards), sudden onset and severe, neurological symptoms
  • previous treatments trialled including maximum dose reached and duration of therapy for headaches/migraines
  • height and weight

Additional information to assist triage categorisation

  • body mass index (BMI) if child is aged ≥ 16 years
  • growth chart trends
  • blood pressure trends
  • neurological examination findings
  • ophthalmology/optometry assessment
  • headache diary
  • history of significant head injury
  • sleep quality and duration, including apnoea or snoring
  • use of alcohol, tobacco, and other drugs
  • relevant allied health, diagnostic, imaging reports including location of company and accession number

Clinical management advice

The most common primary headaches in children include migraines and tension-type headaches. Viral illnesses often cause secondary headaches. In some cases, headaches may also be a symptom of underlying psychosocial issues.

Visual issues such as eye strain and myopia, along with muscle tension associated with anxiety, teeth grinding, or fatigue, contribute to headaches. Treatment options include simple pain relief, physiotherapy, relaxation techniques, and migraine prevention for those over 16 years of age. It is crucial to assess whether there are underlying mental health concerns such as anxiety, school avoidance, or social stressors that may be contributing to the headaches.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • 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

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.