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Referral
Adult Migraine (with or without aura)
Scope
Adult Migraine (with or without aura)
For any referral, the patient must be recorded to have been tried on prophylaxis for 8-10 weeks following dose titration. If this is not recorded the referral will be returned for addition.
Signs and Symptoms
Suspect migraine in people who present with or without headache and with neurological symptoms that:
- are fully reversible and
- develop gradually, either alone or in succession, over at least 5 minutes and
- last for 5-60 minutes
Diagnose migraine with aura in patients who present with or without headache and with one or more of the following symptoms that meet the criteria listed below:
- Visual symptoms that may be positive (e.g. flickering lights, spots or lines) and/or negative (e.g. partial loss of vision)
- Sensory symptoms that may be positive (e.g. pins and needles) and/or negative (e.g. numbness)
- Speech disturbance
Consider further investigations, e.g. brain imaging and/or referral for patients with or without migraine headache and with any of the following atypical aura symptoms:-
- Motor weakness
- Double vision
- Visual symptoms affecting one eye
- Poor balance
- Decreased level of consciousness
History and Examination
Neurological examination + BP
CRP if any question of Temporal Arteritis
If there is a fixed neurological deficit the patient will need a brain imaging
The acute and prophylactic medical management in Primary Care can be found in the formulary:
Referral Criteria
For a referral, the patient must have tried prophylaxis for 8-10 weeks following dose titration. If this is not recorded the referral will be returned for addition.
A headache diary for 3 months from the patient can help with decisions about on-going treatment.
Referral Instructions
e-Referral Service
- Specialty: Neurology
- Clinic Type: Headache
- Service: DRSS-Western-Neurology-Devon ICB-15N
Referral Form
Evidence
National Institute for Health and Clinical Excellence (2012) [Headaches: Diagnosis and management of headaches in young people and adults]. [CG150].
British Association for the study of Headache (2010) [Guidelines for all Healthcare Professionals in the Diagnosis and Management of: Migraine, Tension-Type, Cluster and Medication-Overuse Headache]. [3rd Edition]
Pathway Group
Author: S Weatherby, Consultant Neurologist, PHNT / Dr G Lenden Clinical lead DRSS Western on behalf of NHS Devon
Publication date: January 2017
