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Neurologia. 2017 Sep 1. pii: S0213-4853(17)30268-2. doi: 10.1016/j.nrl.2017.08.001. [Epub ahead of print]

How and when to refer patients diagnosed with primary headache and craniofacial neuralgia in the Emergency department or Primary Care: Recommendations of the Spanish Society of Neurology's Headache Study Group.

[Article in English, Spanish]

Author information

Unidad de Cefaleas, Servicio de Neurología, Instituto de Investigación Sanitaria Princesa, Hospital Universitario de la Princesa, Madrid, España. Electronic address:
Unidad de Cefaleas, Hospital Clínico Universitario de Valladolid, España.
Servicio de Neurología, Hospital Universitario Sant Joan de Déu, Fundación Althaia, Manresa, Barcelona, España.
Servicio de Neurología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España.
Unidad de Cefalea, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Investigación en Cefalea, VHIR, Universitat Autònoma Barcelona, España.
Unidad de Cefaleas - Servicio de Neurología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
Unidad Gestión Clínica de Neurología, Hospital Virgen Macarena, Sevilla, España.



When a patient is diagnosed with primary headache or craniofacial neuralgia in the emergency department or in primary care, and is referred to a neurologist due to the complexity of the case, it is useful to know whether additional examination should be sought and the priority (urgent, preferential or normal) with which the patient should be seen. This will avoid unnecessary delays in patients with disabling headache and where organic causes are suspected. In order to issue recommendations on this matter, the Spanish Society of Neurology's Headache Study Group has decided to create a series of agreed recommendations constituting a referral protocol for patients with headache and/or craniofacial neuralgia.


Young neurologists with an interest and experience in headache were invited to draft a series of practical guidelines in collaboration with Spanish Society of Neurology's Headache Study Group Executive Committee. For practical reasons, the document was divided into 2 articles: this first article focuses on primary headaches and craniofacial neuralgias and the second on secondary headaches. In order for the recommendations to be helpful for daily practice they follow a practical approach, with tables summarising referral criteria, examinations to be performed, and referral to other specialists.


We hope to offer a guide and tools to improve decision-making regarding patients with headache, identifying complementary tests to prioritise and referral pathways to be followed, in order to avoid duplicated consultations and delayed diagnosis and treatment.


Atención primaria; Cefalea; Complementary test; Derivación; Emergency department; Headache; Neuralgia; Patient referral; Primary care; Pruebas complementarias; Urgencias

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