When to refer

As headaches are so common, many people will downplay their symptoms, so it’s important to be able to identify when a customer should be referred. Signs that something is not quite right include a headache that:

• Is worsening and is accompanied by a fever
• Has a sudden onset and becomes severe very quickly
• Is triggered by pressure changes such as sneezing, moving from standing to sitting, or exercising
• Has changed significantly since it began or has been present for a long time
• Follows an accident or knock to the head
• Does not respond to OTC analgesics within a day
• Is in someone with a compromised immune system, such as a patient undergoing cancer treatment
• Follows exposure to or withdrawal from a substance
• Is accompanied by vomiting without an obvious cause, a painful red eye, personality changes, lockjaw, impaired consciousness or other signs of neurological or cognitive problems, such as memory loss or numbness, slurred speech or confusion.