Prior to any appointment reception will require a valid referral for any Medicare rebate and migraine patient questionnaire completed.

At our migraine clinic we advise our patients to allow referrals a duration period to be triaged and once reception is informed and if you qualify for an appointment, we will get back to you.

Be advised that Dr Casse is no longer taking on any general neurology, with only assisting with EEG and Nerve Conduction Studies. Dr Casse is specialising only in/ and consulting Chronic Migraines, Headaches; Cervical Dystonia and injectable therapy.

All referrals are triaged by Dr Casse, however all new migraine and headache patients will go through our specialist GP first. We will contact you as soon as we can. However, please allow our reception staff a duration period as we receive multiple referrals a day and have to triage them all through our specialist.

Before your appointment
Prior to any appointment reception will require a valid referral for any Medicare rebate and an acquaintance form completed.

For all patients, please ensure you bring any relevant letters from other specialists, investigations such as blood tests or imaging results to your appointment. Dr Casse will be interested to know what treatments you are currently on (prescribed or over the counter) and which ones you have tried previously.

For new patient headache appointments:
1. Please keep a diary of significant and milder headaches
2. Since headache is often longstanding and complex, please complete this chart of what treatments you have tried and any effects.

Routine history taking begins with a set of standard questions that will elicit basic information and, depending on the acuity of onset, the age of the patient and whether he/she presents to in the consulting.

In every headache patient, our worry and the patients fear are that no serious life-threatening cause should be overlooked. It is then important to keep in mind the “red flags,” therefore, Dr Casse will ask the right questions to be able to decide whether the patient could be having a serious secondary headache warranting further investigation.

Any new onset headache or anything that is atypical for a particular type of primary headache should get you worried about the presence of a secondary headache and warrant imaging.

Typical questions may include;

Is this your first or worst headache? How bad is your pain on a scale of 1 to 10
(1 means manageable and 10 means severe)?

• Do you have headaches on a regular basis? Is this headache like the ones you usually have?
• What symptoms do you have before the headache starts?
• What symptoms do you have during the headache?
• What symptoms do you have right now?
• When did this headache begin? How did it start (gradually, suddenly, other)?
• Where is your pain? Does the pain seem to spread to any other area? If so, where?
• What kind of pain do you have (throbbing, stabbing, dull, other)?
• Do you have other medical problems? If so, what?
• Do you take any medicines? If so, what?
• Have you recently hurt your head or had a medical or dental procedure?

If you suffer from chronic migraines, are over 18 years of age, not pregnant, breastfeeding or planning for a pregnancy in the next 3 months you should consider injection therapy. You should also consider the therapy if at least 3 preventative medications provided from your doctor have limiting side effects or have been unable to provide you with significant benefit.

Preventative medications include: Propranolol, Pizotifen, Candesartan, Topiramate, Amitriptyline, Sodium Valpoate & Verapamil. Whilst Triptans are an effective acute migraine treatment they are not a preventative therapy.