Ophthalmological Headache

Availability

North South North West Statewide

Pre-referral work-up

History

Headache associated with ocular signs and/or symptoms

Most headaches do not need ophthalmic assessment unless there are eye signs.

All referrals should comply with the Standard Referral guidelines and include in particular:

  • Duration of headache and description of headache pattern
    • Warning sign of facial tenderness over temple and watering eye
    • Jaw claudication
    • Waking with headache
    • Headache associated with nausea
    • Neurologic signs or symptoms
  • Associated ocular signs and symptoms such as
    • Vision reduced or sudden loss of vision
    • Amaurosis fugax (transient loss of vision)
    • Sudden field loss
    • Exophthalmos or orbital mass
    • Red eye
    • Epiphora
    • Diplopia
    • Ptosis
    • Suspected papilloedema
    • Pain on eye movements
  • Cranial nerve examination
  • Comorbidities

Tests

  • Immediate ESR/CRP/FBE in suspected giant cell arteritis and refer as emergency (no need to wait for results)

Interim/GP management

To refer a patient with this condition, please see the Ophthalmology clinic page for the full referral process and templates.

Most headaches do not need ophthalmic assessment unless there are eye signs.

For more information please see the Tasmanian Health Pathways website.

Emergency

Emergency - ring on call Ophthalmic Registrar to discuss.

Painful red eye

Amarosis fugax

Sudden loss of or reduction in vision

Giant cell arteritis or other vascular disease

Sudden onset diplopia

Sudden onset ptosis

Suspected papilloedema or raised intracranial pressure

Sudden field loss associated with ocular signs or symptoms

Suspected herpes simplex or herpes zoster ophthalmicus

Urgent / category 1

Ocular pathology associated with headache

Intracranial lesion requiring fields

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED
– Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED
– Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED
– Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED
– Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review and the referral must be faxed.

We will endeavour to see these patients within ten days, or sooner if clinically indicated.

Semi-urgent:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment