Aims Headaches in childhood are commonly referred to paediatric neurology, necessitating the use of tertiary resources. In most of these situations, simple advice by primary or secondary care practitioners may be all that is needed. The aim of our study is to review the referrals of childhood headache to paediatric neurology services in a tertiary unit in United Kingdom.

Methods We analysed 60 referrals to two paediatric neurologists at a tertiary hospital over a span of one year by reviewing clinic letters filed on the local hospital network. Our inclusion criteria were all children under the age of sixteen years who were referred with headache as the primary presenting complaint. Those with a previous or pre-existing diagnosis already explaining their headache were excluded from our study.

Results Majority of the referrals (87%) were from general practitioners, with the remaining from secondary paediatrics. Interestingly, 8% were not on any analgesia at the time of their first paediatric neurology appointment. About two thirds of referral letters suggested brain imaging as one of the reasons for referral, mainly to exclude a space occupying lesion. After assessment, only 18% of children underwent brain MRI and in all these cases, no secondary cause to explain their headache was detected. Primary headache was therefore the final diagnosis made in all cases. Of these, majority of children had a psychosocial trigger for their headaches. Of those diagnosed with migraine, prophylaxis was commenced in 86% of cases after the first consultation. Advice and reassurance were provided to the remaining children seen, with no further investigations carried out.

Conclusions In summary, majority of cases referred to tertiary services can probably be dealt with at a primary or secondary level. We believe that better education and improved awareness amongst practitioners at this level will help in the overall management of childhood headaches in the UK.