OSCE Headache Differential Diagnoses –
All Specialties Summary

Medicine & Allied – Headache

Cause

Key Features

Pain Type

Red Flags

Migraine

Unilateral, aura, nausea

Throbbing

Aura with neuro signs

Tension

Bilateral, stress

Band-like, dull

Change in pattern

Cluster

Orbital, tearing, male

Severe, stabbing

Horner’s, agitation

SAH

Sudden, LOC

Thunderclap

Photophobia, stiff neck

Temporal Arteritis

Elderly, jaw pain, vision risk

Temporal, constant

Vision loss, ↑ESR

Brain Tumor

Morning, vomiting, vision blur

Pressure-like

Papilledema

Surgery & Allied – Headache

Cause

Key Features

Pain Type

Red Flags

Meningitis

Post-op, photophobia

Diffuse

Neck stiffness

Pituitary Apoplexy

Sudden vision loss, shock

Retro-orbital

Hypotension, vomiting

Abscess

Otitis hx, seizures

Localized

Fever, focal signs

Hydrocephalus

Post-trauma, papilledema

Persistent, pressure

Visual change, trauma hx

OB-GYN – Headache

Cause

Key Features

Pain Type

Red Flags

Preeclampsia

HTN, vision issues

Frontal, throbbing

Seizures, RUQ pain

CVT

Postpartum, seizures

Variable

Focal signs

Pituitary Apoplexy

Postpartum, collapse

Sudden, severe

Lactation failure

Pediatrics – Headache

Cause

Key Features

Pain Type

Red Flags

Migraine

Family hx, photophobia

Pulsatile

Aura, behavior change

Tension

School stress

Dull, tight

Persistent, mood issues

Tumor

Morning, vomiting

Progressive

Papilledema, gait issues

Hydrocephalus

Irritability, large head

Diffuse

Sunset sign, fontanelle bulge

Flashcard Set: OSCE – History Taking – Headache

(Medicine & Allied)

SECTION A: Foundational History-Taking

Q1: What’s the ideal opening question in a headache OSCE?
A: “Can you tell me more about your headache?”

Q2: What structured mnemonic guides detailed headache history?
A: SOCRATES (Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/relieving factors, Severity)

Q3: What important associated symptoms should be asked?
A: Fever, photophobia, neck stiffness, nausea, vomiting, visual changes, weakness, numbness, confusion, seizures.

SECTION B: Red Flags in Medical Headache

Q4: What red flag suggests meningitis?
A: Fever + neck stiffness + photophobia

Q5: What red flag suggests subarachnoid hemorrhage (SAH)?
A: Sudden “thunderclap” headache, worst ever, ± LOC

Q6: What feature suggests temporal arteritis (GCA)?
A: Headache + scalp tenderness + jaw claudication + age >50

Q7: What red flag may indicate brain tumor?
A: Early morning headache with vomiting, seizures, focal neurological signs

Q8: What red flag combination suggests raised intracranial pressure?
A: Headache worse when lying down, blurred vision, papilledema

SECTION C: Common Medical Headache Types

Q9: What are classic features of migraine?
A: Unilateral, throbbing headache ± aura, nausea, photophobia, worsened by activity

Q10: What is the typical presentation of tension-type headache?
A: Bilateral, dull pressure/tight band-like pain, no nausea or photophobia

Q11: What features suggest cluster headache?
A: Unilateral periorbital pain + lacrimation, nasal congestion, occurs in bouts, awakens from sleep

Q12: What is medication-overuse headache?
A: Chronic daily headache due to overuse of analgesics (paracetamol, NSAIDs, triptans)

SECTION D: System-Specific Medical Clues

Q13: What endocrine disorder may present with headache and visual symptoms?
A: Pituitary adenoma (bitemporal hemianopia)

Q14: What neurological signs are important to ask in any headache case?
A: Visual changes, speech disturbance, weakness, numbness, balance or gait issues, seizures

Q15: What autoimmune condition in elderly can cause new-onset headache?
A: Temporal arteritis (Giant cell arteritis)

Q16: What metabolic disturbance commonly causes headache in diabetics?
A: Hypoglycemia

Q17: What feature suggests idiopathic intracranial hypertension (IIH)?
A: Obese female, headache + visual blurring + papilledema

SECTION E: Prioritization & Triage

Q18: Which headache cases need urgent CT scan?
A: Sudden severe headache, trauma, focal neurological signs, new seizure, altered consciousness

Q19: What questions help rule out meningitis in OSCE?
A: “Do you have neck stiffness?” / “Any fever or rash?” / “Are you feeling confused or drowsy?”

SECTION F: Communication & Empathy

Q20: How do you reassure a patient with migraine but normal MRI?
A: Explain the diagnosis simply, validate their pain, provide lifestyle advice, and discuss treatment options.

Q21: What’s an empathetic phrase during headache OSCE history?
A: “That must be very difficult to deal with.” / “You’ve done the right thing by coming in.”

Q22: What phrases can help address patient’s brain tumor fears despite normal imaging?
A: “I understand your concern. Thankfully, your imaging was normal, which is very reassuring.”

Q23: How do you differentiate tension headache from migraine in OSCE?
A: Ask about photophobia, nausea, and impact on daily life. Tension headache is milder and lacks these.

Q24: What is the final step in OSCE history-taking?
A: Summarize findings, explain next steps, thank the patient, and offer follow-up.

Q25: What lifestyle advice should be offered for primary headache disorders?
A: Regular sleep, stress management, hydration, avoiding caffeine and triggers

Summary table 

Headache Differentials – Medicine & Allied (OSCE-Focused)

Headache Differentials – Medicine & Allied (OSCE-Focused)

Cause

Key Clinical Features

Pain Character

Associated Symptoms

Red Flags

Migraine

  • Recurrent, unilateral, 
  • often with aura

Throbbing/pulsatile

  • Nausea, 
  • photophobia, 
  • phonophobia
  • Aura with vision loss, 
  • stroke symptoms in young female

Tension Headache

  • Bilateral, 
  • daily or stress-related
  • Dull, 
  • pressure-like
  • No nausea or 
  • photophobia

Sudden change in headache pattern

Cluster Headache

  • Male, 
  • unilateral periorbital pain,
  • occurs in clusters
  • Severe, 
  • sharp, 
  • piercing
  • Lacrimation, 
  • nasal congestion, 
  • ptosis
  • Horner’s syndrome, 
  • severe agitation

Subarachnoid Hemorrhage

Sudden onset, “worst headache of life”

  • Thunderclap, 
  • rapidly peaking
  • LOC, 
  • neck stiffness,
  • photophobia
  • Sudden onset, 
  • LOC, 
  • focal deficits

Temporal Arteritis

Elderly with scalp tenderness, jaw claudication

  • Constant, 
  • temporal region
  • Vision loss, 
  • fatigue
  • Visual loss, 
  • age >50, 
  • elevated ESR

Hypertensive Crisis

  • Severe BP elevation, 
  • occipital headache

Pulsating or dull

  • Blurred vision,
  • nausea
  • BP >180/120,
  • end-organ damage signs

Raised ICP (Tumor)

  • Worse in morning, 
  • vomiting, 
  • visual changes
  • Pressure-like, 
  • constant
  • Blurred vision, 
  • vomiting, 
  • seizures
  • Papilledema, 
  • focal neurological signs

Flashcard Set: OSCE – History Taking – Headache

 (Surgery & Allied)

SECTION A: Initial Approach and General History

Q1: How do you begin history taking in a patient presenting with headache in surgical OPD?
A: Introduce yourself, confirm patient identity, explain purpose, gain consent, ask about headache onset and characteristics.

Q2: What are the main headache characteristics to explore?
A: Onset, location, duration, frequency, intensity, type (throbbing, sharp), aggravating/relieving factors.

Q3: Why is it important to ask about trauma history in surgical patients with headache?
A: To rule out traumatic brain injury, subdural/epidural hematoma, or skull fractures.

SECTION B: Red Flags for Urgent Surgical Conditions

Q4: What headache features suggest raised intracranial pressure requiring urgent surgical referral?
A: Early morning headache, vomiting, vision changes, papilledema, altered consciousness.

Q5: What are red flags indicating possible intracranial hemorrhage?
A: Sudden onset “thunderclap” headache, neurological deficits, seizures, decreased consciousness.

Q6: What systemic signs suggest infection that may require surgical intervention (e.g., abscess)?
A: Fever, neck stiffness, localized swelling, altered sensorium.

SECTION C: Associated Symptoms and Systemic History

Q7: What neurological symptoms must be asked in a surgical patient with headache?
A: Weakness, numbness, visual disturbances, speech difficulties, seizures.

Q8: Why inquire about vomiting and its pattern?
A: Projectile vomiting suggests raised intracranial pressure or mass effect.

Q9: What is the importance of asking about prior surgeries or interventions?
A: To identify post-surgical complications or recurrence of pathology.

Q10: Why should you ask about anticoagulant or antiplatelet use?
A: To assess risk of bleeding complications like intracranial hemorrhage.

SECTION D: Differential Diagnoses Relevant to Surgery

Q11: What surgical causes of headache should be considered?
A: Brain tumors, subdural hematoma, epidural hematoma, brain abscess, hydrocephalus.

Q12: How to differentiate migraine from surgical causes in history?
A: Migraine is recurrent, associated with aura and triggers; surgical causes usually acute and progressive.

Q13: What signs suggest temporal arteritis needing biopsy and treatment?
A: Scalp tenderness, jaw claudication, visual loss, raised ESR.

Q14: What clues in history suggest sinusitis-related headache?
A: Facial pain, nasal congestion, fever, purulent nasal discharge.

SECTION E: Communication and Empathy

Q15: How to explain the need for urgent investigations to a worried patient?
A: “We need to do some scans to make sure there is no serious problem that needs quick treatment.”

Q16: What empathetic statement helps ease patient anxiety about headaches?
A: “I understand headaches can be very distressing. We will work together to find the cause and help you.”

Q17: How do you involve the patient in decision-making?
A: Ask about their concerns, explain options clearly, check for understanding.

SECTION F: Triage and Management Planning

Q18: What headache symptoms require immediate surgical referral?
A: Sudden severe headache, neurological deficits, worsening headache, decreased consciousness.

Q19: When is imaging mandatory in headache patients in surgery?
A: Red flags present, new neurological signs, history of trauma, worsening symptoms.

Q20: What lifestyle factors should be assessed in chronic headache patients?
A: Stress, sleep, caffeine, medications, alcohol use.

SECTION G: Practical OSCE Tips for History Taking

Q21: How to document headache history effectively?
A: Use SOCRATES: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors, Severity.

Q22: What questions help assess impact of headache on daily activities?
A: Effect on sleep, work, mood, concentration.

Q23: Why ask about family history of neurological or vascular diseases?
A: To identify genetic predispositions like aneurysms or migraines.

Q24: How to safely conclude the history-taking station?
A: Summarize main points, confirm any urgent symptoms, thank patient.

Q25: What infection control measure is important in surgical history taking?
A: Use gloves when examining for neck stiffness or wounds, hand hygiene.

Summary table 

Headache Differentials – Surgery & Allied (OSCE-Focused)

Cause

Key Clinical Features

Pain Character

Associated Symptoms

Red Flags

Post-Op Meningitis

Post-neurosurgery or cranial procedure

Diffuse persistent

  • Fever, 
  • photophobia, 
  • neck stiffness
  • Immunocompromised,
  • worsening LOC

Pituitary Apoplexy

Sudden onset + visual loss + hypotension

Severe frontal or retro-orbital

  • Vomiting, 
  • ophthalmoplegia
  • Visual loss, 
  • hypotension, 
  • hypopituitarism

Intracranial Abscess

Chronic otitis or sinus infection history

  • Localized,
  • worsening
  • Fever, 
  • vomiting, 
  • seizures
  • Seizures, 
  • focal deficits,
  • mastoiditis

CSF Leak Headache

Post-spinal or cranial surgery

Orthostatic (worse standing up)

  • Neck stiffness,
  • clear nasal/ear discharge
  • Clear discharge, 
  • positional worsening

Hydrocephalus (Post-Trauma)

Post-head injury with progressive headache + visual changes

Constant pressure-like

  • Papilledema,
  • altered mentation
  • Vomiting, 
  • vision changes, 
  • gait disturbance

 

Flashcard Set: OSCE – History Taking – Headache

 (Obstetrics & Gynaecology)

SECTION A: Initial History Approach

Q1: How should you start a headache history in a pregnant woman?
A: Greet the patient, introduce yourself, ensure privacy, obtain consent, and ask, “Can you describe your headache?”

Q2: What key headache details should be elicited?
A: Onset, duration, site, severity, nature, associated symptoms, frequency, timing with gestational age

Q3: What are the main associated symptoms to ask in a pregnant patient with headache?
A: Blurred vision, photophobia, nausea, vomiting, abdominal pain, leg swelling, seizures, fever

SECTION B: Obstetric Red Flags in Headache

Q4: What is a red flag suggesting eclampsia?
A: Headache + visual disturbance + hypertension + seizures

Q5: What features suggest preeclampsia as a cause of headache?
A: New-onset headache after 20 weeks + hypertension + proteinuria ± visual symptoms

Q6: What feature may indicate cerebral venous thrombosis (CVT)?
A: Severe headache + seizures + focal neurological signs + postpartum period

Q7: What is a dangerous but common postpartum cause of positional headache?
A: Post-dural puncture headache (PDPH) – after spinal anesthesia or epidural

Q8: What red flag should be asked in a patient with a history of SLE presenting with headache?
A: Features of CNS vasculitis or thrombosis – confusion, seizure, focal deficits

SECTION C: Differential Diagnosis – Pregnancy

Q9: What are common benign causes of headache in pregnancy?
A: Tension headache, migraine, sinusitis, dehydration, anemia, poor sleep

Q10: What dangerous differential must be excluded in all late pregnancy headache cases?
A: Pre-eclampsia and intracranial hemorrhage

Q11: What is the key feature of a post-dural puncture headache (PDPH)?
A: Occurs 24–48 hrs after spinal/epidural, worse when sitting or standing, relieved by lying down

Q12: What headache condition is associated with hormonal changes during menstruation or pregnancy?
A: Migraine with or without aura

SECTION D: System-Specific Evaluation

Q13: What visual symptoms raise concern in pregnant women with headache?
A: Blurred vision, flashing lights, visual field defects – consider preeclampsia or pituitary apoplexy

Q14: What symptoms suggest pituitary apoplexy in postpartum headache?
A: Sudden headache + vision loss + altered consciousness in a woman with known macroadenoma

Q15: What is the importance of asking about previous similar headaches?
A: Helps distinguish primary headache (e.g., migraine) from new serious secondary causes

Q16: What GI symptom in third-trimester headache is highly suspicious?
A: Epigastric pain or RUQ pain – consider HELLP syndrome or preeclampsia

SECTION E: Risk Stratification and Triage

Q17: Which headache symptoms mandate immediate obstetric referral?
A: Seizures, confusion, severe hypertension, visual loss, LOC

Q18: In postpartum headache, what makes CVT more likely?
A: Headache + limb weakness/seizures + postpartum state, especially in patients with thrombophilia

Q19: What lab tests support the diagnosis of preeclampsia in headache workup?
A: Urine protein, CBC (for platelets), LFTs, and BP measurement

SECTION F: Communication & Empathy

Q20: How do you handle a patient fearful of brain tumor during pregnancy?
A: Acknowledge concern, explain that most pregnancy headaches are benign, and recommend appropriate imaging if red flags exist

Q21: What phrase shows empathy to a worried antenatal mother with persistent headache?
A: “I understand this must be very stressful during your pregnancy. Let’s work through this together.”

Q22: How do you explain the seriousness of preeclampsia to a patient gently?
A: “This condition can affect both you and your baby’s health, but we have effective ways to monitor and manage it.”

SECTION G: Practical OSCE Tips

Q23: What to always ask in obstetric headache OSCE?
A: Gestational age, BP history, visual changes, seizures, abdominal pain, and swelling

Q24: How do you summarize and close this OSCE?
A: Recap symptoms, express concern for red flags if present, explain need for tests/referral, and thank the patient

Q25: What lifestyle advice can help prevent benign headaches in pregnancy?
A: Hydration, sleep hygiene, small frequent meals, avoiding known migraine triggers

Summary table

Headache Differentials – Obs/Gyn (OSCE-Focused)

Cause

Key Clinical Features

Pain Character

Associated Symptoms

Red Flags

Preeclampsia/Eclampsia

  • Pregnancy >20 weeks, 
  • high BP, 
  • proteinuria
  • Throbbing,
  • frontal or diffuse
  • Visual disturbances, 
  • epigastric pain
  • BP >140/90, seizures, 
  • organ dysfunction

Cerebral Venous Thrombosis

  • Postpartum or OCP use, 
  • prothrombotic state
  • Severe, 
  • often unilateral
  • Seizures, 
  • focal deficits
  • Neurological signs, 
  • papilledema

Migraine (Pregnancy)

Often improves in pregnancy but may worsen in 1st trimester

  • Pulsatile, 
  • unilateral
  • Nausea, 
  • photophobia,
  • aura

Sudden change in migraine pattern

Pituitary Apoplexy (Sheehan’s)

  • Postpartum hemorrhage, 
  • lactation failure

Severe sudden headache

  • Hypotension, 
  • visual symptoms
  • Hypopituitarism,
  • hypotension

Anemia-Related Headache

  • Gradual onset in 2nd–3rd trimester, 
  • pallor
  • Dull, 
  • bilateral
  • Fatigue, 
  • dizziness

Hb <7, syncopal episodes

 

Flashcard Set: OSCE – History Taking – Headache

 (Pediatrics Station)

SECTION A: Initial History & Approach

Q1: How do you start a headache history in a child during OSCE?
A: Introduce yourself, greet child and parent, ensure comfort, get permission to talk, ask child to describe headache or ask parent if child is very young.

Q2: What are the key headache characteristics to ask in pediatric patients?
A: Onset, duration, location, intensity, frequency, type (throbbing, sharp), timing, triggers

Q3: Why is it important to ask about developmental milestones and school performance in a child with headache?
A: To assess if headache affects cognition or if neurological issues exist

SECTION B: Red Flags in Pediatric Headache

Q4: What are red flags for serious intracranial pathology in a child with headache?
A: Vomiting, early morning headache, altered consciousness, seizures, focal neurological deficits

Q5: What headache features suggest raised intracranial pressure?
A: Worse in the morning, vomiting, papilledema, vision changes

Q6: What systemic signs would you check to rule out infection causing headache?
A: Fever, neck stiffness, irritability, photophobia

Q7: What features suggest migraine in children?
A: Recurrent headaches, family history, nausea, photophobia, phonophobia, aura possible

SECTION C: Associated Symptoms & History

Q8: What should you ask about associated symptoms in pediatric headache?
A: Vomiting, vision changes, weakness, dizziness, behavioral changes

Q9: Why is it important to ask about recent head trauma?
A: To rule out concussion or intracranial bleed

Q10: What questions are important about the child’s sleep?
A: Sleep duration, quality, snoring or apnea (can cause morning headache)

Q11: What role does family history play in pediatric headache?
A: Helps identify migraines or genetic disorders

SECTION D: Systemic & Differential Diagnoses

Q12: What infections can cause headache in children?
A: Meningitis, encephalitis, sinusitis, otitis media

Q13: What signs suggest tension headache?
A: Stress-related, bilateral pressing headache, no neurological deficits

Q14: What features indicate a need for urgent neuroimaging?
A: Focal neuro signs, persistent vomiting, worsening headache, seizures

Q15: How can anemia contribute to headache in children?
A: Reduced oxygen delivery can cause chronic headache and fatigue

SECTION E: Communication & Empathy

Q16: How do you communicate effectively with a young child in OSCE?
A: Use simple language, be patient, engage parent for answers, use play or drawings if needed

Q17: What empathetic statement can you say to a worried parent?
A: “I understand it’s worrying to see your child in pain, we will do our best to find out the cause.”

Q18: How to reassure the child during history taking?
A: “You’re doing great, thank you for telling me about your headache.”

SECTION F: Triage and Management

Q19: What signs in pediatric headache require urgent referral?
A: Seizures, altered consciousness, worsening symptoms, focal neurological signs

Q20: What lifestyle advice is important for children with recurrent headache?
A: Regular sleep, hydration, healthy diet, limit screen time, avoid headache triggers

SECTION G: Practical OSCE Tips

Q21: What must you document carefully in pediatric headache history?
A: Onset, triggers, family history, neurological symptoms, impact on daily life

Q22: How to involve parents in the history taking?
A: Ask about changes in behavior, school performance, and home environment

Q23: Why ask about medications and recent vaccinations?
A: To rule out medication side effects or post-vaccination headache

Q24: What is the importance of asking about vision or hearing changes?
A: Could indicate neurological or ENT causes needing further evaluation

Q25: How do you end the history-taking station politely?
A: Summarize findings, thank child and parents, explain next steps

Summary table 

Headache Differentials – Pediatric (OSCE-Focused)

Cause

Key Clinical Features

Pain Character

Associated Symptoms

Red Flags

Migraine (Pediatric)

  • Family history, 
  • triggers (light, food)
  • Pulsatile, 
  • often frontal or bilateral
  • Nausea, 
  • photophobia
  • Aura, 
  • vomiting, 
  • behavioral changes

Tension Headache (School-Age)

  • Stress-related, 
  • school performance issues
  • Dull, 
  • band-like
  • Poor sleep,
  • anxiety
  • Daily persistent pattern, 
  • school absenteeism

Brain Tumor (Raised ICP)

  • Morning headache, 
  • vomiting, 
  • gait disturbance
  • Persistent, 
  • progressive
  • Blurred vision,
  • irritability
  • Papilledema, 
  • growth regression

Hydrocephalus

  • Increasing head circumference, 
  • developmental delay (infants)

Pressure-like

  • Irritability, 
  • vomiting
  • Bulging fontanelle, 
  • sun-setting eyes

Post-Meningitis Sequelae

History of prior CNS infection

  • Persistent, 
  • post-inflammatory
  • Hearing loss,
  • seizures
  • Seizures, 
  • altered mental status