headache (adult, criteria for urgent referral)
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Refer urgently patients with:

  • symptoms related to the CNS in whom a brain tumour is suspected, including:
    • progressive neurological deficit
    • new-onset seizures
    • headaches
    • mental changes
    • cranial nerve palsy
    • unilateral sensorineural deafness
  • headaches of recent onset accompanied by features suggestive of raised intracranial pressure, for example:
    • vomiting
    • drowsiness
    • posture-related headache
    • pulse-synchronous tinnitus
    • or by other focal or non-focal neurological symptoms, for example blackout, change in personality or memory
  • a new, qualitatively different, unexplained headache that becomes progressively severe
  • suspected recent-onset seizures (refer to neurologist)

Refer urgently patients previously diagnosed with any cancer who develop any of the following symptoms:

  • recent-onset seizure
  • progressive neurological deficit
  • persistent headaches
  • new mental or cognitive changes
  • new neurological signs.

Consider urgent referral (to an appropriate specialist) in patients with rapid progression of:

  • subacute focal neurological deficit
  • unexplained cognitive impairment, behavioural disturbance or slowness, or a combination of these
  • personality changes confirmed by a witness and for which there is no reasonable explanation even in the absence of the other symptoms and signs of a brain tumour

Consider non-urgent referral or discussion with specialist for:

  • unexplained headaches of recent onset:
    • present for at least 1 month
    • not accompanied by features suggestive of raised intracranial pressure.

Reference:

  1. NICE (June 2005). Referral Guidelines for Suspected Cancer

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