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IM17.1-14 | Headache — Assignment

CLINICAL SCENARIO

This assignment asks you to produce a structured clinical evaluation and management plan for a patient presenting with headache in the outpatient setting. You will apply the SNNOOP10 red-flag framework, ICHD-3 classification criteria, and evidence-based pharmacological management to a provided clinical vignette, demonstrating constructive alignment between history-taking, diagnosis, investigation, and treatment.

Instructions

Use the clinical vignette provided by your faculty to complete all five sections. Write in structured clinical language. Do not copy SDL text verbatim — apply the knowledge to reason through the specific case. Ensure all pharmacological doses are specified. Word limit: 1,100–1,400 words.

Length: 1,100–1,400 words across all sections

What to Submit

Section 1: Structured Headache History and ICHD-3 Classification

Guidance: Using the clinical vignette, document the structured headache history in SOCRATES format (Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/relieving factors, Severity). Apply the SNNOOP10 red-flag checklist systematically — state which red flags are present and which are absent. Classify the headache according to ICHD-3, citing each criterion met (e.g., number of attacks, duration, character, associated features, aggravation by activity). Approximately 300 words.

Section 2: Neurological Examination

Guidance: Describe the neurological examination you would perform in this patient. Include: general assessment (GCS, vital signs including blood pressure), fundoscopy for papilloedema, cranial nerve examination (specifically which nerves and why), assessment for meningeal signs (neck stiffness, Kernig, Brudzinski), cerebellar examination, and gait if relevant. For each component, state what you are looking for and what a positive finding would indicate. Document both expected positive and negative findings relevant to the vignette. Approximately 250 words.

Section 3: Differential Diagnosis and Investigation Strategy

Guidance: List your top 3 diagnoses in rank order of probability. For each diagnosis, provide: (a) the key positive features supporting it, and (b) the key features arguing against it. Then construct an investigation plan. For each investigation you order, state the specific clinical finding that justifies it. For imaging, explicitly state whether you would order CT, MRI, or neither — and why. Your imaging decision must be connected to your SNNOOP10 assessment. Approximately 300 words.

Section 4: Pharmacological Management Plan

Guidance: Provide a complete management plan for: (a) acute treatment of individual attacks — name the drug(s), class, mechanism of action, dose, route, and timing; (b) preventive therapy — state the indication (number of attacks per month, functional impact), first-line agent with dose, and how long to trial before assessing efficacy; (c) contraindications — identify any specific contraindications for this patient to your chosen agents; (d) medication-overuse headache prevention — state the frequency threshold for acute medications above which MOH risk applies. Approximately 300 words.

Section 5: Patient Counselling Note

Guidance: Write a brief counselling note addressed to the patient (in plain English). Cover: (1) the name of the diagnosis in lay terms; (2) lifestyle triggers to identify and avoid; (3) how to use acute medication correctly, including the frequency limit to prevent medication-overuse headache; (4) warning signs that should prompt immediate hospital attendance (list specific red-flag symptoms). If prophylaxis is prescribed, explain why daily medication is needed even when feeling well. Approximately 150 words.

Grading Rubric — Headache Clinical Evaluation and Management Plan Rubric

Criterion	Points	Full-marks descriptor
History and Classification (Section 1): Takes a structured headache history applying SNNOOP10 red-flag screening; classifies the headache using ICHD-3 criteria with explicit justification for each criterion met.	20 pts	SNNOOP10 applied systematically with each relevant item noted as present or absent; ICHD-3 classification stated with every diagnostic criterion explicitly cited (e.g., number of attacks, duration, character, associated features); clinical reasoning clearly connects history data to classification.
Neurological Examination Documentation (Section 2): Describes a structured neurological examination specific to a headache patient including cranial nerve assessment, fundoscopy, meningeal signs, and cerebellar testing; interprets the significance of positive and negative findings.	20 pts	Examination documented in organ-system order with all relevant components: fundoscopy for papilloedema, cranial nerves (especially III, IV, VI for raised ICP; VII for facial asymmetry), meningeal signs (Kernig, Brudzinski, neck stiffness), cerebellar signs; negative findings explicitly recorded; significance of each finding explained.
Differential Diagnosis and Investigation Plan (Section 3): Generates a structured differential diagnosis with primary and secondary causes ranked by probability; selects and justifies investigations using the SNNOOP10 findings and ICHD-3 classification to guide imaging decisions.	25 pts	At least 3 differentials listed in probability order with evidence for and against each; investigation plan is selective (not a blanket panel) with each test justified by a specific clinical finding; imaging decision explicitly justified against SNNOOP10 findings (scan vs no scan rationale stated).
Management Plan (Section 4): Provides a complete acute and preventive treatment plan (if applicable) with correct pharmacological agents, doses, and contraindications addressed; identifies medication-overuse risk.	25 pts	Acute treatment: correct drug(s) with mechanism, dose, and timing; prophylaxis: indication correctly stated (>=4 attacks/month or functional impairment), first-line agent with dose and duration of assessment; contraindications addressed (e.g., triptan in CAD, valproate in women of childbearing age); MOH risk explicitly addressed with threshold (>=10 days/month for triptans).
Patient Counselling Note (Section 5): Writes a concise counselling note for the patient addressing lifestyle triggers, the role and correct use of acute medication, when to seek emergency care, and adherence to prophylaxis; uses plain language.	10 pts	All four elements present: lifestyle/trigger advice; correct use of acute medication with explicit limit to prevent MOH; emergency warning symptoms clearly listed (thunderclap, meningism, focal deficit, visual loss); prophylaxis adherence addressed. Plain language throughout.

PEER REVIEW

Review your peer's assignment using the five rubric criteria. For each criterion, assign a score from the rating scale and write one specific comment justifying your score — do not simply reproduce the descriptor. Pay particular attention to: (1) whether every ICHD-3 criterion for the diagnosis is explicitly cited; (2) whether the investigation plan is selective and justified by specific findings, not a blanket panel; (3) whether the pharmacological doses are correct and contraindications addressed; (4) whether the counselling note states a specific frequency limit for acute medications. Complete your review within 72 hours of submission.