Solomon Award Lecture: Observations 2020 - 'Teaching Headache'

R. Allan Purdy, MD, FAHS

AHSAM 2020 - Oral session
Published on July 17, 2020


5 minute read

Key messages

  • The field of neurology underlines clinical and basic science and is, therefore, an important subject to be taught to medical students.
  • Migraine aura is the neurological signature of migraine and plays a pivotal role in migraine diagnosis in a subset of patients.
  • Patient case studies remain an invaluable educational tool, demonstrating both classical and unusual migraine presentations that provide a source for differential diagnosis discussion.
  • Basic teaching concepts will remain in the future, but educational resources will move to a more remote online format that also allows for live case-based discussion.

Key messages

  • The field of neurology underlines clinical and basic science and is, therefore, an important subject to be taught to medical students.
  • Migraine aura is the neurological signature of migraine and plays a pivotal role in migraine diagnosis in a subset of patients.
  • Patient case studies remain an invaluable educational tool, demonstrating both classical and unusual migraine presentations that provide a source for differential diagnosis discussion.
  • Basic teaching concepts will remain in the future, but educational resources will move to a more remote online format that also allows for live case-based discussion.

Background

  • The basic teaching concept of headache and neurology education requires an eager student who has an insatiable curiosity and an interested teacher.

Content summary

Importance of migraine with aura in diagnosis

  • Migraine symptomology should be carefully analyzed due to the overlap with many other neurological disorders.
  • Migraine aura is the neurological signature of migraine and plays a pivotal role in migraine diagnosis in a subset of patients.
  • In migraine with aura, the aura can follow premonitory symptoms or precede headache, and persist through the headache phase.
  • In comparison, in migraine without aura the characteristics of the premonitory symptoms and headache are all that is available to make the diagnosis of migraine.
  • Aura can also occur without headache and premonitory symptoms, usually in older individuals who experience a flurry of attacks.

Figure: The borderland of migraine1

 

Why neurology is so important in teaching headache

  • Migraine informs how the brain is working in normal and abnormal states, an area there is still much to learn.
  • Neurology underlines clinical and basic science and is, therefore, an important subject to be taught.

Why all cases count in teaching headache

  • Patient case studies remain an invaluable educational tool, demonstrating both classical and unusual migraine presentations that provide a source for differential diagnosis discussion.
  • Headaches have multiple phenotypes including migraine with aura, chronic migraine, cluster headaches and dangerous thunderclap headaches, which are of particular concern to clinicians.
  • Diagnosis should take into account the different location and physiology of blood vessels in the brain, particularly when considering a diagnosis of thunderclap headache.
  • Up until recently, physical examination and case history have been the foundations of understanding neurology and headache disorders.
  • Every interaction in educational, clinical medicine is picked up by the student, therefore, teachers have a tremendous influence on the outcomes.
  • It is important to remember it isn’t a disease or exam that sticks in the mind of a student, but how the subject was taught and in the context of a patient.

Conclusions

The future of teaching? Where is it headed now?

  • The COVID-19 pandemic has had a profound impact on the way neurology and headache medicine is taught.
  • The basic teaching concepts will remain in the future, but teaching will move to a more remote online format that will also incorporate live case-based discussion.

This is a highlights summary of an oral session given at the AHSAM 2020 Virtual Annual Scientific Meeting and presented by:

R. Allan Purdy, MD, FAHS
Professor of Medicine (Neurology)
Dalhousie University
Halifax, Nova Scotia, Canada

The content is produced by Infomedica, the official reporting partner of ASHAM 2020 Virtual Annual Scientific Meeting. The summary text was drafted by Goldcrest Medical Writing, reviewed by Marco Vercellino, MD, an independent external expert, and approved by Jessica Ailani, MD, FAHS and Mark J. Burish, MD, PhD, the scientific editors of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.

1. Angus-Leppan H. Migraine: mimics, borderlands and chameleons. Pract Neurol. 2013;13(5):308-318. 



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