Headaches represent a significant proportion of referrals to any neurology consult service. The WHO ‘’pain ladder’’, primarily designed for cancer pain relief, is often used by primary care physicians and emergency departments in management of headache disorders. The prolonged use of these agents can lead to medication overuse headache. Headache specific treatment guidelines (e.g. NICE guidelines) have been published but compliance with such guidelines is unclear.

A retrospective chart review of neurology consults referred with headache over three 6-month periods was conducted between 2011 and present. Data collected included: patient demographics; the primary team’s diagnosis of headache syndrome; imaging; cerebrospinal fluid analysis; final diagnosis made by neurology service and changes in treatment. We assessed the indication for brain imaging according to NICE guidelines for Headache (2015) and examined trends in the above data over time.

Headache remains a common referral reason to the neurology service. Initial investigations are appropriate in over two thirds of such patients. However, pharmacological treatment, in particular the inappropriate prescription of opiates, remains suboptimal.