These guidelines have been produced to guide clinical decision making for general practitioners (GPs). They are not strict protocols. Clinical common-sense should be applied at all times. These clinical guidelines should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each case and the needs of each patient. Clinicians should also consider the local skill level available and their local area policies before following any guideline.



  If child is unwell and presents with a headache and any of the following, send to the nearest Emergency Department immediately:  

  • Headache with fever and neck stiffness
  • Headache or vomiting disrupting sleep or on waking
  • Headache that is acute and severe
  • Headache with accelerated/progressive course
  • Changes in personality, behaviour, and/or increased drowsiness
  • Focal neurological signs or visual impairment
  • Seizures


Headaches can be categorised into two types:

Primary Headaches

Where the headaches occur on their own not from another underlying medical condition. (1, 2, 3, 4, 5, 6, 7)

These include migraines, cluster headaches, tension headaches, chronic daily headaches. (1, 2, 3, 4, 5, 6, 7)

Secondary Headaches

Where the headaches are due to an underlying medical condition(3, 5, 6)

These include tumours, vascular lesions, hydrocephalus, sinusitis, viral infections etc. (3, 5, 6)

Pre-referral history, examination and investigations

Clinical history including:

  • Duration and frequency
  • Location and nature of pain
  • Worsening severity
  • Associated features (nausea and vomiting, neurological signs)
  • Exacerbating and relieving factors
  • Effect on the level of daily functioning (e.g. missing/affecting school or usual activities, affecting sleep)
  • Significant analgesia use

Symptoms requiring further investigation:

Physical examination including:

  • Growth parameters (e.g. Increasing head circumference)
  • Blood pressure
  • Neurological examination (for focal abnormalities or signs of raised intracranial pressure – papilloedema, strabismus, focal weakness, abnormal reflexes, ataxia, altered mental state)
  • Neck stiffness or photophobia
  • For older child / adolescent, consider MRI brain at time of referral if significant concern

For more information on headache management guidelines, see Health Pathways-Headaches in Children


Pre-referral management

  • Lifestyle advice
    • Improving sleep hygiene and educate on adequate sleep hours for age
    • Eating regular meals and having adequate hydration
    • Encourage usual activities and exercise as tolerated
    • Learning relaxation techniques
    • Keeping a headache diary (see useful resources below)
    • Avoid triggers
  • Pharmacological therapy
    • Simple Analgesia- paracetamol and ibuprofen
      • Limit to 3 times a week to prevent medication overuse headache
  • Consider Sumatriptan if migraine suspected ≥10 year old (in conjunction with simple analgesia)
  • If neurological symptoms are suspected to be due to underlying pathology such as a space occupying lesion or hydrocephalus, please present to the nearest Emergency Department
    • If sufficient concern, consider MRI brain
    • A GP can order an MRI of the head for any patient under the age of 16 with specific neurological symptoms as per the Medicare Benefits Schedule (MBS)

When to refer

  • Refer to PCH General Paediatrics Department if:
    • MRI results are abnormal
    • Child is having recurring headaches and not responding to initial GP management
    • Child is presenting with a headache and any red flag sign in the box above

How to refer

  • Routine non-urgent referrals from a GP or a Consultant should go to the Central Referral Service
  • Routine non-urgent referrals from a nurse practitioner, non-medical referrers or private hospitals go to the PCH Referral Office
  • Urgent referrals (less than seven days) are made via the PCH Referral Office. Please call PCH Switch on 6456 2222 to discuss referral with the on-call General Paediatrician

Essential information to include in your referral

  • Relevant medical history including detailed history of headaches
  • Any concerning features
  • All treatment trialled and current management
  • Results from any tests performed
    • If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons, please state in referral


  1. Parisi P, Papetti L et al. Tension type headache in paediatric age. Acta Paediatrica 2011; 100:491-495
  2. Stuart Lewis K. Pediatric headache, Seminars in Pediatric Neurology 2010; 17:224-229.
  3. Özge A, Termine C et al. Overview of diagnosis and management of paediatric headache. Part 1: diagnosis, 2010. Journal of headache and pain; 12: 13-23.
  4. Whitehouse WP, Agrawal S. Management of children and young people with headache, Archives Disease Childhood Educ Pract Ed 2017;102:58– 65
  5. Seshia SS. Chronic daily headache in children and adolescents, 2012. Current pain headache rep; 16:60-72.
  6. Termine C, Özge A et al. Overview of diagnosis and management of paediatric headache. Part II: therapeutic management, 2011. Journal of headache and pain; 12: 25-34
  7. Clinical Practice Guidelines : Headache (rch.org.au) https://www.rch.org.au/clinicalguide/guideline_index/Headache/


Reviewer/Team: General Paediatrics Review date: March 2023
Endorsed by:
CPAC Next review date: March 2026

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Useful resources