When should I consider referring a patient with idiopathic intracranial hypertension to a specialist?

Consider referring a patient with idiopathic intracranial hypertension (IIH) to a specialist if:

• There is diagnostic uncertainty or atypical symptoms that make the diagnosis unclear.
• Symptoms persist despite optimal management in primary care.
• There are any red flags or suspicion of a serious underlying cause of headache.
• The patient has visual symptoms or signs suggestive of raised intracranial pressure requiring specialist assessment.
• Specialist advice is needed for management decisions, including treatment initiation or escalation.

Referral urgency depends on clinical judgement, especially if red flags or serious secondary causes are suspected. Early specialist involvement is important to prevent complications such as vision loss.

These recommendations align with NICE guidance on headache management and the British Association for the Study of Headache (BASH) guidelines, which emphasize referral when diagnosis is uncertain, symptoms persist despite treatment, or red flags are present ¹,².