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 |
| Throbbing/pulsatile |
|
|
Tension Headache |
|
|
| Sudden change in headache pattern |
Cluster Headache |
|
|
|
|
Subarachnoid Hemorrhage | Sudden onset, “worst headache of life” |
|
|
|
Temporal Arteritis | Elderly with scalp tenderness, jaw claudication |
|
|
|
Hypertensive Crisis |
| Pulsating or dull |
|
|
Raised ICP (Tumor) |
|
|
|
|
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 |
|
|
Pituitary Apoplexy | Sudden onset + visual loss + hypotension | Severe frontal or retro-orbital |
|
|
Intracranial Abscess | Chronic otitis or sinus infection history |
|
|
|
CSF Leak Headache | Post-spinal or cranial surgery | Orthostatic (worse standing up) |
|
|
Hydrocephalus (Post-Trauma) | Post-head injury with progressive headache + visual changes | Constant pressure-like |
|
|
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 |
|
|
|
|
Cerebral Venous Thrombosis |
|
|
|
|
Migraine (Pregnancy) | Often improves in pregnancy but may worsen in 1st trimester |
|
| Sudden change in migraine pattern |
Pituitary Apoplexy (Sheehan’s) |
| Severe sudden headache |
|
|
Anemia-Related Headache |
|
|
| 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) |
|
|
|
|
Tension Headache (School-Age) |
|
|
|
|
Brain Tumor (Raised ICP) |
|
|
|
|
Hydrocephalus |
| Pressure-like |
|
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Post-Meningitis Sequelae | History of prior CNS infection |
|
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