Neurology

NICE CG150 · ESO 2022 · ILAE 2022 · EAN Guidelines

1 in 6
People affected by neurological disorders
15M+
Strokes per year globally
50M
People with epilepsy worldwide
1 in 3
People have significant headache disorder

Neurology in Primary Care

Neurological presentations account for 10–15% of all GP consultations. Most are benign and manageable in primary care — but the stakes for missing a serious diagnosis are high. Headache, dizziness, and weakness are among the most common and most anxiety-provoking presentations. Know the red flags, act fast on strokes, and refer strategically.

Stroke: "Time is Brain"Headache: SNOOP4 Red FlagsEpilepsy: AED Safety in WomenParkinson's: Refer Before Treating
Thunderclap headache = SAH until proven otherwise. Any sudden-onset severe headache reaching maximum intensity within seconds to 1 minute — CT head urgently. If CT negative, LP at ≥12h for xanthochromia.

Thunderclap headache

999 / A&E immediately

Sudden maximal onset ("worst headache of life") — subarachnoid haemorrhage until proven otherwise

Headache + fever + neck stiffness

999 — IM Benzylpenicillin 1.2g before transfer

Bacterial meningitis / meningoencephalitis

New headache >50 years

Urgent ESR/CRP, ophthalmology if visual symptoms

GCA (temporal arteritis), intracranial pathology

Headache + papilloedema

Same-day CT head

Raised ICP — tumour, venous sinus thrombosis, idiopathic intracranial HTN

Progressive headache worsening over weeks

Urgent CT/MRI referral

Space-occupying lesion

Postural headache (worse lying, better sitting)

Urgent ophthalmology + neurology referral

Idiopathic intracranial hypertension (IIH) — especially obese women of childbearing age

Headache + focal neuro deficit

CT head urgently

Haemorrhagic stroke, tumour

Headache after head trauma

CT head (NICE head injury criteria)

Subdural/extradural haematoma

SNOOP4 — Secondary Headache Screening Tool

S

Systemic symptoms (fever, weight loss)

N

Neurological signs (focal deficit, papilloedema)

O

Onset sudden / thunderclap

O

Older age (new headache >50 yrs)

P

Progressive worsening over weeks

P

Postural / position-related change

P

Precipitated by Valsalva (cough, sneeze, exertion)

P

Pregnancy or postpartum

Cardiovascular

AF, anticoagulation

Hypertension

Stroke risk reduction

Drug Database

AEDs, neuropathic pain

Mental Health

Depression in neurological disease

Based on NICE CG150 (Headache), NICE CG137 (Epilepsy), ESO Stroke Guidelines 2022, NICE NG128 (Parkinson's), EAN Guidelines. Always refer to specialist for new neurological diagnosis.