As headaches are so common, many people will downplay their symptoms, so it’s important to be able to identify when someone needs a referral. Signs that something is not quite right include a headache that:

• Is worsening and accompanied by a fever
• Has a sudden onset and becomes severe very quickly
• Is triggered by pressure changes such as sneezing or moving from standing to sitting, or exercising
• Has changed significantly in nature since it began or has been present for a long time
• Follows an accident or knock to the head
• Is not getting better despite trying the usual things, including preventative measures
• Is in someone with a compromised immune system, for example someone undergoing cancer treatment
• Follows exposure to or withdrawal from a substance
• Is accompanied by vomiting without an obvious cause; a painful red eye; personality changes; lockjaw; impaired consciousness; or other signs of neurological or cognitive problems, such as memory loss or numbness, slurred speech or confusion.