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Table 5 Patients likely to be referred to level 3 within optimally structured headache servicesa (adapted from [29])

From: Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description

Patients with:

 • Refractory disabling headache of any type;

 • Cluster headache and other trigeminal autonomic cephalalgias, at first presentation;

 • High and low cerebrospinal fluid-pressure headaches;

 • Trigeminal and other cranial neuralgias or painful lesions of the cranial nerves;

 • Rare primary or secondary headaches;

 • Medication-overuse headache involving drugs of dependence, where personality mitigates against withdrawal of medication or where withdrawal attempts have failed;

 • Other probable or certain serious secondary headache;

 • Headaches with severe physical and/or psychological comorbidities.

Cases of persisting diagnostic uncertainty.

Patients in whom risk of serious underlying disorders demands specialist investigation.

Patients who may participate in specific level-3 research projects (including clinical trials) [66].

  1. adepending in some cases on the facilities and skills available at level 2