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., migraine, chronic daily headache with medication overuse)
2. Secondary headache
   1. Associated with vascular disorders (e.g., severe arterial hypertension)
   2. Associated with non-vascular disorders (e.g., intracranial infection)
   3. Other (e.g., systemic viral infection, carbon monoxide exposure)

Key Objectives

Given a patient with headaches, the candidate will diagnose the cause, severity, and complications, and will 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
   1. symptoms and signs that indicate a need for urgent brain imaging and/or referral for specialized care;
   2. symptoms and signs to differentiate amongst the various causes of headaches;
2. list and interpret critical investigations, including
   1. appropriate and cost-effective laboratory and diagnostic imaging tests;
   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 counseling the patient regarding the causes and management of headaches;
   5. determining if the patient is at risk for narcotic addiction or overuse.