Clinical Scenarios

Clinical Scenario



By the end of Family Medicine Clerkship, students will be able to:

1. Perform a patient-centered interview that identifies:
a.  Symptoms of secondary headaches, including red flags of potentially serious causes: e.g. intracranial bleed, meningitis, etc.
b. Features that may differentiate types of headache that commonly presents in primary care e.g. migraine, tension, cervicogenic, and medication over-use headaches.

2. Perform a focused physical exam that identifies signs of secondary causes, including potentially serious causes.

3. Use diagnostic criteria to diagnose a patient with migraine.

4. Propose a management plan that includes:
a. Appropriate and timely investigation & disposition if a potentially serious secondary cause is suspected.
b. Includes appropriate evidence-informed pharmacological and non-pharmacological modalities.
c. Response to patient fears and expectations providing reassurance when appropriate

Clinical Cards



Recommended Resources Addressing the Objectives

Evaluation of acute headaches in adults (8 pages)

Objectives covered: 1ab, 2, 3, 4a
Clinch CR. Evaluation of acute headaches in adults. Am Fam Physician 2001 Feb 15;63(4):685-692.

Breaking the cycle of medication overuse headache (7 pages)

Objectives covered: 1b, 4bc
Tepper SJ, Tepper DE. Breaking the cycle of medication overuse headache. Cleve Clin J Med 2010 Apr;77(4):236-242.

TOP Guidelines for Primary Care Management of Headache in Adults (2 pages)

Objectives covered: 4bc
Towards Optimized Practice (TOP). Guideline for Primary Care Management of Headache in Adults. 2012; Available at: Accessed July/15, 2014.

Foundational Knowledge

The Calgary Guide – Pathophysiology behind why headaches occur

Additional Resources

Top 10 causes of headache in family medicine, plus clinical pearls (1 page)

Objectives covered: 1a, 4c
Ponka D, Kirlew M. Top 10 differential diagnoses in family medicine: Headache. Can Fam Physician 2007 Oct;53(10):1733.