Return to Scenario ListShow Learning Points most relevant to Phase 1:


Clinical Discipline(s)/Organ System(s)
General Practice, Neurology, Nervous System, Otorhinolaryngology
Progress Test Topic(s)
A 50 year old NZ European woman presents to her GP with frontal headaches for three months. When her headache is at its worst her vision seems blurred. There have been no other neurological symptoms. She is a married factory worker who is facing redundancy.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Pathophysiological theories of headaches and migraine
   - Pathophysiology of chronic pain
   - Pathophysiology of drug withdrawal syndromes and how they pertain to analgesia/caffeine withdrawal
   - Pharmacology of tryptans,
antidepressants, beta adrenoceptor blocking drugs, anticonvulsants, non-steroidal anti-inflammatory drugs

Clinical and Communication Skills 
   - History from a patient with headache including analgesia rebound headache and migraine
   - Perform a focused neurological examination
   - Differential diagnosis of
headache and awareness of prevalence

   - Indications for head and neck CT or MRI
   - Management of common headache presentations and migraines
   - Outline non-pharmacological treatment for headaches
   - Discuss with patient regarding the psycho-socio-biological relationship in headaches
   - Structuring, framing and timing of primary care consultation
Personal and Professional Skills 
   - Awareness of patient concerns regarding cerebral bleeds or tumours in chronic headaches
   - Awareness of anxiety around brain scanning; communicating risks of incidental findings, and claustrophobia
   - Reassure patient without needing to recourse to doing every last investigation
   - Psychology of management of stress
   - Headache as a somatisation symptom
Hauora Māori 
   - Mirimiri in the non-pharmacological management of headache
   - Understanding of inequities in access to health services and quality of medical care for Māori and application of this to clinical decision-making
Population Health 
   - Epidemiology of migraine/headache and social impact
   - Costs of unnecessary population screening
Conditions to be considered relating to this scenario
tension headache, migraine, sinusitis, temporomandibular joint dysfunction, obstructive sleep apnoea
Less common but 'important not to miss'
giant cell arteritis, space occupying lesion
trigeminal neuralgia, cluster headache, polycythaemia vera, benign intracranial hypertension