Getting a headache referral on the NHS: what to expect
Most migraine is diagnosed and treated by GPs, and plenty of people never need to see a specialist. But if treatment isn't working, the diagnosis isn't clear, or your headaches have changed, a referral makes sense. Here's how it usually works, and how to make the wait count.
When a GP is likely to refer
There's no single rule, but a referral is common when:
- you've tried two or three preventive medicines without enough benefit
- you have headaches on most days of the month
- the pattern is unusual, or doesn't fit migraine or tension-type headache
- you're taking painkillers so often that medication overuse headache is likely
Don't wait for a referral if a headache comes on suddenly and severely, or comes with weakness, confusion, changes in your vision, or fever and a stiff neck. These need same-day help from 111, 999 or A&E.
Who you might see
"Headache clinic" can mean a few different things. You might see a consultant neurologist, a headache specialist nurse, or a GP with extra training in headache. All of them can confirm a diagnosis and change your treatment. More complex cases are passed on to a specialist centre.
How long it takes
In England, the NHS Constitution says that for non-urgent conditions you should start consultant-led treatment within 18 weeks of being referred. In reality, neurology waits vary a lot from one area to another, and some are longer. Scotland, Wales and Northern Ireland have their own targets.
If you live in England, you can also choose which hospital or clinic you're referred to for your first appointment, as long as it's consultant-led. Ask your GP what's available. A clinic a little further away can sometimes mean a much shorter wait.
You don't always have to go through your GP. The National Migraine Centre, a charity based in London, sees patients without a GP referral, including by video. Private headache clinics are another option if you can afford one.
What your GP can do while you wait
Being on a waiting list doesn't mean nothing can change in the meantime. Your GP can:
- start or change a preventive, such as propranolol, amitriptyline, topiramate or candesartan. Not all of them suit everyone, particularly if you're pregnant or planning a pregnancy.
- try a different triptan, or a triptan together with an anti-inflammatory such as naproxen
- help you cut back on painkillers if you're taking them on too many days (see our guide to medication overuse headache)
Make the appointment count
Specialist appointments are short, and the most useful thing you can bring is a record. Keep a headache diary for at least eight weeks before you go. Note which days you had a headache, how bad it was, and what you took for it. Also write down every preventive you've tried, with the dose, how long you took it and why you stopped.
It sounds like homework, but it changes the conversation. Instead of relying on memory, your specialist can see the pattern straight away and make decisions in that first appointment.
Start your record before the appointment.Log each headache in under a minute with the free Migrevention diary.
Get the free diaryIf nothing arrives
If weeks go by without a letter, first check with your GP surgery that the referral was actually sent. After that, contact the hospital's booking team, or the NHS e-Referral Service on 0345 608 8888. If your headaches get worse or change while you wait, tell your GP. They can ask for the referral to be moved forward.
Sources: NHS, Referrals for specialist care. The NHS Constitution for England. NICE CG150, Headaches in over 12s.
