OSCE — Headache

Brief (to candidate)

You will assess a patient with a presentation consistent with Headache.^[1] You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.^[1]

Clinical context

Headache (cephalalgia) is pain arising from the pain-sensitive structures of the head (dura, vessels, sinuses, scalp, cervical roots, cranial nerves V, VII, IX, X) but NOT the brain parenchyma itself (it is insensate). The single most important clinical step is to separate primary from secondary headache using the SNNOOP10 red-flag screen: a secondary headache has an underlying cause (haemorrhage, infection, mass, giant-cell arteritis, raised pressure) and may be life-threatening. The three primary headaches are migraine (unilateral throbbing, 4 to 72 h, photophobia, phonophobia, nausea, aura in one-third), tension-type (bilateral pressing band, no nausea, not aggravated by routine), and cluster (strictly unilateral orbital pain 15 to 180 minutes with ipsilateral lacrimation, conjunctival injection and partial Horner syndrome, in bouts).^[1]

Candidate tasks

1. Clarify onset, severity, associated features, and red-flag symptoms.^[1]
2. State focused examination priorities.
3. List first-line investigations and any named score/criteria.^[1]
4. Give immediate resuscitation steps.
5. Outline definitive management with doses/routes where standard.^[1]
6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).^[1]
7. Mention one special-population modifier (pregnancy, child, elderly, CKD).^[1]

Examiner checklist

Model outline

Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.^[1]

References3ShowHide

1. [1]Eigenbrodt AK, Ashina H, Khan S, et al. Diagnosis and management of migraine in ten steps Nat Rev Neurol, 2021.PMID 34145431
2. [2]Perry JJ, Stiell IG, Sivilotti MLA, et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache JAMA, 2013.PMID 24065011
3. [3]Holroyd KA, O'Donnell FJ, Stensland M, et al. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination JAMA, 2001.PMID 11325322