● Urgent care clinic · 30-minute consult
Headache
Screen SNOOP, then treat tension and migraine well — and avoid opioids.
Typical consult⏱ 15–20 min
Investigations🔬 Usually none
Usual outcome💊 Simple analgesia ± triptan + antiemetic
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
1Rule out first — red flags
| If you find… | …then |
|---|---|
| Thunderclap (worst ever, peak within 5 min) | SAH — ED now |
| Fever, neck stiffness, rash, confusion | Meningitis — ED now |
| New neuro deficit, seizure, reduced GCS, papilloedema | Intracranial lesion — ED |
| Age > 50, jaw claudication, scalp tenderness, visual symptoms | GCA — ESR/CRP, prednisolone, same-day pathway |
| Pregnant / postpartum | Pre-eclampsia, venous sinus thrombosis |
| Cancer, immunosuppression, worse lying / coughing, morning vomiting | Raised ICP |
2Focused history
3Focused examination
4Decide — investigate only if it changes the plan
SNOOP
- Systemic symptoms / secondary risk factors (cancer, HIV, immunosuppression)
- Neurological signs
- Onset sudden / Older age (> 50 new headache)
- Pattern change / Positional / Papilloedema / Precipitated by Valsalva / Pregnancy
Any SNOOP feature → this is not a primary headache until proven otherwise.
| Investigation | Only if… |
|---|---|
| None | Primary headache |
| ESR/CRP | Suspected GCA |
| BP + urine dip | Pregnant / postpartum |
5Treat & send home
Management & advice
- Tension-type: simple analgesia, hydration, sleep, posture; avoid overuse
- Migraine: treat early; dark quiet room
- Medication overuse: simple analgesics < 15 days/month, triptans/codeine < 10 days/month
- Headache diary; GP for prophylaxis if frequent
- Avoid opioids for headache
Refer / follow-up
- Red flags → ED
- Frequent migraine / medication overuse → GP
℞
Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.
| Drug | Dose | Duration / notes |
|---|---|---|
| Paracetamol | 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) | As needed |
| Ibuprofen | 400 mg (up to 600 mg) as a single dose, max three times a day | As needed |
| Migraine: sumatriptan | 50 mg (up to 100 mg); may repeat once after 2 h if headache returns (max 300 mg/24 h) | Avoid in cardiovascular disease, uncontrolled hypertension |
| Migraine nausea: metoclopramide | 10 mg up to three times a day | Max 5 days (or prochlorperazine) |
6Safety-net
Say it like this
This sounds like a migraine. The examination is normal, which is reassuring. Take the triptan as soon as a migraine starts, with ibuprofen or paracetamol, and try not to use painkillers on more than 2 or 3 days a week, as that can cause more headaches. Call 999 if you get a sudden, severe headache, a stiff neck with fever, or weakness or problems speaking or seeing.
Come back / call 111 — or 999 if severe — if:
- Sudden severe headache, “worst ever”
- Fever with stiff neck, rash or confusion
- Weakness, numbness, problems with speech or vision, fit
- Headache with jaw pain on chewing or scalp tenderness (over 50)
7Patient leaflets — scan & go
Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.
8Document
Headache — clinic note
A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.
URGENT CARE — HEADACHE
PRESENTING COMPLAINT:
HISTORY
Onset (sudden?), duration, pattern, location:
Aura, nausea, photophobia (migraine); band-like (tension):
SNOOP red flags (above):
Analgesic use days/month (medication overuse):
Pregnancy, contraception (combined pill + migraine with aura):
RED FLAGS (record present / absent)
[ ] Thunderclap (worst ever, peak within 5 min)
[ ] Fever, neck stiffness, rash, confusion
[ ] New neuro deficit, seizure, reduced GCS, papilloedema
[ ] Age > 50, jaw claudication, scalp tenderness, visual symptoms
[ ] Pregnant / postpartum
[ ] Cancer, immunosuppression, worse lying / coughing, morning vomiting
PMH:
DRUG HISTORY:
ALLERGIES:
SOCIAL (job / who is at home / driving):
OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 )
EXAMINATION
Obs incl. BP and temperature:
Neuro exam incl. cranial nerves, pupils, gait:
Fundoscopy:
Temporal arteries (> 50):
Neck stiffness:
DECISION RULE — SNOOP: result ______
INVESTIGATIONS: none required / None, ESR/CRP, BP + urine dip — result:
IMPRESSION:
PLAN
Treatment / TTO (drug, dose, duration):
Advice given:
Leaflet given (QR / printed): Headaches, Migraine
Follow-up / referral:
SAFETY-NETTING (told to return / call 111 / 999 if):
- Sudden severe headache, “worst ever”
- Fever with stiff neck, rash or confusion
- Weakness, numbness, problems with speech or vision, fit
- Headache with jaw pain on chewing or scalp tenderness (over 50)
Patient understands and agrees with the plan: Y / N
Seen by: Grade: Date/Time:
✓Guidelines
Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.
More infections & medical
Cough & chest infectionBronchitis vs pneumonia, and the NICE rules on antibiotics.Lower UTIDiagnose on symptoms, choose by eGFR and pregnancy, spot pyelonephritis.Diarrhoea & vomitingRehydrate, rule out the surgical belly and the C. diff, and keep them off work.Calf pain & suspected DVTTwo-level Wells, D-dimer, scan within 4 h or anticoagulate.