Presentations – emergency
- Acute pain
- Bladder / Bowel dysfunction
- Sudden onset new severe headache
- Sudden onset weakness / sensory disturbance
Presentations – headache
- Asthenia / Fatigue
- Dysesthesia / Numbness
- Neuropathic pain
- Pain / Stiffness, chronic
- Weakness
Conditions – acute
- Central causes, such as:
- demyelination
- stroke, including:
- cerebral venous thrombosis
- intracerebral haemorrhagic
- ischaemic
- Peripheral nerves, such as:
- Guillain–Barré syndrome
- inflammatory plexopathies
- Primary headache disorders, such as:
- cluster headache
- glossopharyngeal neuralgia
- trigeminal autonomic cephalgias
- trigeminal neuralgia
Conditions – chronic
- Conversion disorder / Functional neurological disorder
- Peripheral nerves:
- entrapment neuropathies
- peripheral neuropathies:
- radiculopathies
- Primary headache disorders, such as:
- migraine
- tension-type headache
- trigeminal autonomic cephalgias
- Secondary headache disorders, such as:
- benign sex headache
- cervical arterial dissection
- cervicogenic headaches
- giant cell arteritis
- idiopathic intracranial hypertension
- low pressure headaches
- medication overuse headache
- myofascial pain syndrome
- reversible vasoconstriction syndrome
- space-occupying lesions
- temporomandibular joint disorders
- tumour
Conditions – emergency
- Central / Peripheral:
- giant cell arteritis
- meningoencephalitis
- subarachnoid haemorrhage
- traumatic brain injury, including:
- Spinal cord:
- demyelinating conditions, including:
- multiple sclerosis
- neuromyelitis optica spectrum disorder (NMOSD)
- extrinsic compression
- ischaemia, including:
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
- Vasculitis / cerebrovascular inflammatory conditions
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
- Common, rare, primary, and secondary diseases that result in headache, pain, and sensory disturbance
- 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
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
- opening pressure
- special tests:
- oligoclonal bands
- spectrophotometry
Clinical neurophysiology investigations
- Electromyography (EMG):
- evoked potentials:
- brainstem
- somatosensory
- visual
- needle EMG
- Nerve conduction studies (NCS):
- motor and sensory studies
Neurogenetic investigations
- Genetic testing, including, but not limited to:
- chromosomal testing, such as:
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
- Referral to a neurogeneticist
Neuroimaging investigations
- CT, including:
- CT angiography
- perfusion
- venography
- MRI, including:
- functional (fMRI)
- magnetic resonance:
- angiography (MRA)
- spectroscopy (MRS)
- venogram (MRV)
- with contrast
- Myelography
- Vascular imaging:
- catheter angiography
- neuroimmunology investigations
Neuroimmunology investigations
- Autoantibody measurement:
- anti-aquaporin 4 and myelin oligodendrocyte antibodies
- paraneoplastic antibodies
- Referral to a neuroimmunologist
Neuropathology investigations
- Biopsy:
- brain
- muscle
- nerve
- temporal artery
Neuropsychological investigations
- Cognitive screening:
- Mini-Mental State Examination
- Montreal Cognitive Assessment
- Rowland Universal Dementia Assessment Scale
- Referral to a neuropsychologist
Other investigations
- Polysomnography
- Serum investigations:
- autoimmune screen
- blood glucose
- electrolytes
- full blood count
- infective serology
- inflammatory markers
- thrombophilia screen
- toxic / metabolic screen, including heavy metals, and mineral or vitamin deficiency
- Importance of early diagnosis and treatment of acute conditions, such as:
- giant cell arteritis
- meningitis
- subarachnoid haemorrhage
- Knowledge and treatment strategies for psychosocial effects and drivers of pain
- Management strategies for the common types of headaches, such as:
- acute
- non-pharmaceutical interventions
- preventative
- rational use of medications
- Overlap with other allied health and medical specialties, such as pain services, physiotherapy, and rehabilitation medicine, and when it is appropriate to refer
- Overlap with other medical conditions, such as depression / anxiety and sleep apnoea
- Prognosis and economic and lifestyle implications of these disorders
