Headache

Rationale

Headache is a common clinical presentation. Patients with headaches due to serious or life-threatening conditions must be differentiated from those with benign primary headache disorders.

Causal Conditions

(list not exhaustive)

1. Primary headache (e.g., tension-type, migraine, chronic daily headache with medication overuse)
2. Secondary headache
   1. Attributed to trauma or injury to the head and/or neck
   2. Attributed to cranial or cervical vascular disorder
   3. Attributed to nonvascular intracranial disorder
   4. Attributed to infection
   5. Other causes (e.g., substance use or withdrawal, disorder of homeostasis)

Key Objectives

Given a patient with headaches, the candidate will diagnose the cause, severity, and complications, and initiate an appropriate management plan. Particular attention should be paid to differentiating benign causes of headaches from potentially serious causes.

Enabling Objectives

Given a patient with headaches, the candidate will:

1. list and interpret critical clinical findings, including those based on
   1. symptoms and signs to differentiate among the various causes of headaches, and
   2. symptoms and signs that indicate a need for urgent brain imaging and/or referral for specialized care;
2. list and interpret critical investigations, including
   1. appropriate and cost-effective laboratory and diagnostic imaging tests, and
   2. indications and contraindications for lumbar puncture;
3. construct an effective management plan, including
   1. describing and contrasting symptomatic and prophylactic treatments,
   2. avoiding medication overuse,
   3. determining if the patient needs urgent and/or specialized care,
   4. educating and counselling the patient regarding the causes and management of headaches, and
   5. determining if the patient is at risk for problematic substance use.