Headache Referrals — Information for GPs
Practical referral guide for GPs in Sydney and surrounds. When to refer, what to include, and the pathways for Botox and CGRP prescribing.
Call to Discuss: 02 9388 0615When to Refer
Dr Ron Granot — FRACP — accepts referrals for the full range of headache presentations. The most common reasons GPs refer:
Treatment-resistant migraine
- Failed adequate trials of ≥2 preventatives
- Considering Botox (specialist prescription required for PBS)
- Considering CGRP mAbs (specialist prescription required for PBS)
- Medication overuse headache requiring structured withdrawal
Diagnostic uncertainty
- Atypical features or red flags warranting specialist review
- New persistent daily headache
- Headache with focal neurological signs
- Suspected secondary headache after exclusion of obvious causes
Specific syndromes
- Cluster headache (diagnosis + verapamil/triptan management)
- Trigeminal neuralgia (medical management + neurosurgical liaison)
- Vestibular migraine and migraine-associated vertigo
- Hemiplegic and other rare migraine variants
Disability & impact
- Significant work or quality-of-life impact
- Patient requesting specialist review for second opinion
- Medicolegal context (independent assessment)
Red Flags — When ED, Not Neurology
Some headache presentations warrant emergency department assessment rather than outpatient neurology referral. The SNNOOP10 mnemonic is a useful screen — if any of the following are present, consider ED.
Consider Emergency Department
- Thunderclap onset (peak severity within 1 minute) — exclude subarachnoid haemorrhage, RCVS
- New headache with fever, neck stiffness or rash — meningitis until proven otherwise
- Acute focal neurological deficit beyond typical migraine aura
- Headache with altered consciousness, persistent vomiting, or seizures
- Headache after significant head trauma within the previous 30 days
- New headache >50 years with systemic symptoms (consider giant cell arteritis — needs urgent ESR/CRP and steroids)
- Headache in immunocompromised, pregnant, or post-partum patient
- Papilloedema or visual obscurations suggesting raised ICP
For non-urgent but concerning presentations where you'd like to discuss before deciding, please phone the rooms — happy to provide informal triage.
What to Include in the Referral
A focused referral makes the first consultation more productive. Beyond the standard GP referral letter, the following are particularly useful:
Referral letter checklist
- Headache history — onset, frequency, character, duration, associated symptoms (aura, autonomic features, photophobia/phonophobia)
- Trigger pattern and current acute treatment use (frequency of triptan and analgesic use)
- Full list of prior preventatives — name, dose, duration trialled, reason for discontinuation
- Any imaging already done (date, findings)
- Current medications and significant past medical history
- Headache diary — at minimum 1 month of headache days (essential if Botox/CGRP being considered)
- Clinical question — what do you want from the referral? (diagnosis, treatment escalation, Botox/CGRP assessment, second opinion, etc.)
Botox & CGRP Pathways
Both Botox (onabotulinumtoxinA) and CGRP monoclonal antibodies for migraine require specialist prescribing under PBS. Dr Granot is accredited for both pathways.
| Treatment | PBS criteria (summary) | What to send with referral |
|---|---|---|
| Botox (PREEMPT protocol) | Chronic migraine — ≥15 headache days/month with ≥8 migraine days, for ≥3 months. Failed ≥3 preventatives. Not on PBS CGRP. | 1-month headache diary (longer is better). List of preventatives trialled with doses and durations. |
| CGRP mAbs PBS-listed: Emgality, Ajovy, Vyepti Private only: Aimovig | Chronic migraine — ≥8 headache days/month. Failed ≥3 preventatives. Not on PBS Botox. | Headache diary documenting baseline frequency (longer is better). List of preventatives trialled with doses and durations. |
Detail on each: Botox for chronic migraine · CGRP therapies
About Dr Granot
Dr Ron Granot, FRACP is a consultant neurologist based in Bondi Junction. He trained at Prince of Wales Hospital — Sydney's leading neurology and headache training centre — and has managed many thousands of patients with primary headache disorders. He is an accredited Botox injector for chronic migraine (PREEMPT protocol) and an accredited prescriber of all PBS-listed CGRP monoclonal antibodies. He is a Conjoint Lecturer at the University of New South Wales and has appeared on national television (SBS Insight, Channel 7, Channel 10) and radio (2GB, 2UE) discussing migraine and CGRP therapies. Full bio →
Frequently Asked Questions
Q: How quickly will my patient be seen?
Routine new-patient appointments are typically within 2–4 weeks. Urgent referrals are accommodated within days — please call the rooms directly to discuss.
Q: Do you accept telehealth referrals?
Telehealth is used for follow-up and stable management. New-patient consultations are generally in-person for full neurological examination. Botox is administered in-rooms only.
Q: Can I discuss a case informally before referring?
Yes — please call the rooms. Dr Granot is happy to triage by phone where clinically appropriate, particularly for urgent presentations or diagnostic uncertainty.
Q: How are reports returned?
A formal consultation letter is sent to the referring GP within 1–2 working days of the appointment. Botox cycle summaries and PBS continuation reports are sent at each treatment cycle.
Q: What does a typical consultation cost?
Private fees apply. Medicare rebate is processed on the day. A detailed quote is provided at booking.
Refer a Patient
Standard GP referral by fax, email, eReferral, or via the patient. Discuss informal triage by phone.
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