Curriculum standards
Knowledge guides
LG18: Pain, including headaches, facial pain, and sensory loss
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Acute sensory loss
- Back pain
- Bulging fontanelle
- Dizziness
- Fatigue
- Headache – disturbed vision, nausea and/or vomiting
- Muscular difficulties, such as:
- coordination problems
- paralysis
- stiffness
- weakness
- Neuropathic pain
- Pain in head and/or face
- Pins and needles and/or sensory loss
- Reduced level of consciousness
- Sciatica
- Sensory or auditory aura
- Sensory sensitivity
- Speech and/or swallowing difficulties
- Vertigo
- Visual disturbance
Conditions – brain and spine
- Intracranial haemorrhage, such as:
- subarachnoid haemorrhage
- Meningitis and other central nervous system (CNS) infections
- Multiple sclerosis (MS) of brain or spinal cord
- Neuromyelitis optica
- Raised intracranial pressure, including from space-occupying lesions
- Spinal cord compression or ischaemia
- Traumatic brain injury, including:
- concussion
- Vascular conditions, including:
- arteriopathy
- ruptured malformation
- stroke
- Vasculitis
Conditions – peripheral nerve disorders
- Botulism
- Entrapment neuropathies
- Guillain–Barré syndrome
- Other acquired and inherited peripheral neuropathies
- Plexopathies
- Radiculopathies
Conditions – primary headaches
- Migraine-like headaches
- Migraine with brainstem features
- Migraine with or without aura
- New persistent daily headaches
- Status migrainosis
- Tension type headaches
Conditions – secondary headaches
- Idiopathic intracranial hypertension
- Low pressure headaches
- Medication-overuse headache
Conditions – other
- Functional neurological disorders
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Cervicogenic headaches
- Cluster headaches and other trigeminal autonomic cephalalgias
- Glossopharyngeal neuralgia
- Headaches attributed to intracranial arterial disorder, such as:
- reversible cerebral vasoconstriction syndrome (RVCS)
- Myofascial pain syndrome
- Temporomandibular joint disorders
- Trigeminal neuralgia
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Current headache classification, such as International Classification of Headache Disorders (ICHD)
- Headache syndromes
- Identification of secondary headache from underlying causes
- Migraine, migraine equivalents, and migraine variants
- Neuroanatomy, neuropharmacology, and neurophysiology involved in the generation of headache and facial pain
- Neuroanatomy, neuropharmacology, and neurophysiology of the pain pathway, peripheral nerves, and sensory pathways
- Rational use of investigations for headache
- Recognition of tumours presenting without headache
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
- cell count
- cytology
- glucose level
- immunological tests
- microbiological tests
- protein level
- xanthochromia
- fundoscopy
- opening pressure
- special tests:
- anti-myelin oligodendrocyte glycoprotein (MOG) antibodies
- oligoclonal bands
- basic CSF analysis:
Clinical neurophysiology investigations
- Electromyography (EMG):
- needle EMG
- single-fibre EMG
- Nerve conduction studies (NCS):
- motor and sensory studies
- repetitive nerve stimulation
- Vestibular function tests
Neurogenetic investigations
- Genetic testing, including, but not limited to:
- chromosomal testing, such as:
- karyotype
- microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
- chromosomal testing, such as:
- Referral to a neurogeneticist
Neuroimaging investigations
- CT, including:
- CT angiography
- perfusion
- MRI (and other specialised magnetic resonance techniques)
- Vascular imaging:
- catheter angiography
- Doppler ultrasound
Neuroimmmunology investigations
- Autoantibody measurement:
- anti-aquaporin 4 antibodies
- anti-MOG antibodies
- paraneoplastic antibodies
- Referral to a neuroimmunologist
Neuropathology investigations
- Nerve biopsy
- Importance of early diagnosis and treatment of acute conditions
- Knowledge and treatment strategies for psychosocial effects and drivers of pain
- Management strategies for the common types of headache:
- non-pharmaceutical interventions, such as:
- biofeedback
- psychological and relaxation therapies, such as:
- massage
- sleep hygiene
- yoga
- rational use of medications
- use of botulinum toxin and nerve blocks in the management of migraines
- non-pharmaceutical interventions, such as:
- Overlap with other allied health and medical specialties, such as pain services, physiotherapy, and rehabilitation medicine, and when it is appropriate to refer patients
- Overlap with other medical conditions, such as depression
- Prognosis and implications of these disorders