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DRPS : Course Catalogue : Deanery of Clinical Sciences : Pain Management

Postgraduate Course: Clinical Management of Headache Disorders (PAMA11065)

Course Outline
SchoolDeanery of Clinical Sciences CollegeCollege of Medicine and Veterinary Medicine
Credit level (Normal year taken)SCQF Level 11 (Postgraduate)
Course typeOnline Distance Learning AvailabilityAvailable to all students
SCQF Credits20 ECTS Credits10
SummaryHeadache is a global burden

Despite the number of different headache disorders, and the impact they have on society globally, headache is poorly represented in both undergraduate and postgraduate medical education.
A focus on providing education at the primary care level is likely to be the critical step in improving the fortunes of sufferers. The objective of this course is to offer a high quality educational solution. It is hoped that those taking the course will become foci not only for better patient diagnosis and management of headache disorders, but also for teaching and advocacy.
Course description Burden of Illness and Prevalence

Headache is a symptom that is experienced by almost everyone at some time in their life. It affects the majority of people in any given month, with very few ever having a sinister or life-threatening, underlying cause. Despite its prevalence, the subject is often an afterthought in both undergraduate and postgraduate teaching, with students lacking the development of a clear method to contextualise the potential diagnoses, the ability to communicate with sufferers and maximise patient outcomes by setting out clear management strategies. Although patients and professionals obsess about sinister causes, the vast majority have benign headache whose impact and morbidity are commonly underestimated from healthcare professionals to healthcare service administrators, governmental planners and those involved in social care.

In this section we will cover the epidemiology of headache and introduce the concept of burden of disease, both individual and societal, that influences patient behaviour and service provision.

1. Understand the prevalence of headache types
2. Appreciate that assessment is not just about symptoms but also disability.
3. Be familiar with WHO Burden of Illness project and the place of migraine relative to non- headache diagnoses
4. Understand there are direct and indirect costs of headache and be able to be an advocate for sufferers who require better services and better support and understanding across work, chores and social activities as well as from social care.

Diagnosis and Classification

Obtaining a correct diagnosis is key to managing headaches successfully and is an essential step towards the selection of appropriate therapies and long-term success in management. However, an incorrect diagnosis frequently leads to the selection of inappropriate therapies, patients being refractory to treatment, and eventual loss to follow-up. Unfortunately, the latter situation often predominates, and patients remain undiagnosed and under-treated in primary care.
An understanding of the clinical features of primary and secondary headache disorders is essential if you are to formulate a management plan for patients. With this in mind, the ability to quickly recognise the characteristics of commonly presented headaches will allow you to successfully interact with patients and provide them with the most appropriate advice and treatment.

1. Understand the differences between broad categories of headache types, such as episodic and chronic, and primary and secondary headaches
2. Recognise the features of commonly presented headache subtypes such as tension-type headache, migraine, cluster headache and medication overuse headache
3. Use a simple diagnostic questionnaire to quickly identify different headache subtypes
4. Recognise the features of chronic headaches according to internationally accepted guidelines

Treatment of Common Headaches

Once an accurate diagnosis is made, effective treatment options can be suggested to the patient. Treatment refers to rescue medication to minimise the moment of crisis as well as prevention to reduce the number of headache attacks.

Each headache type requires its own specific approach(es) and the options available can be the subject of a number of philosophical strategies eg in rescue for migraine stepped care, stratified care, staged care or individualised care. The use of criteria to match patient to strategy and assess outcome is desirable.

1. Understand the available treatment options for the common headache types.
2. Acknowledge that treatment need may change over time.
3. Recognise ways to assess where to start and the need to follow up and evolve management that is failing.
4. Understand the need to develop a method to understand the evidence in clinical trials and how the evidence affects guidelines and personal practice

Management of Headache

Acute and preventative treatment is part of the wider management options that patients can employ to minimise headache. Other strategies such as trigger avoidance and regulation of lifestyle can also be used┬┐ eating, hydration, exercise and sleep, can all reduce frequency of episodes and disability.
Some may view nutraceuticals such as Vitamin B2, Coenzyme Q10 and Magnesium and devices as being separate to pharmaceuticals. In frequent headache, addressing sleep hygiene, mood, neck and shoulder pain and a sensitized sensory nervous system, allows development of bespoke care which addresses a whole range of contributing factors in an individual patient.

It is also important to appreciate that management may involve a network of professionals ranging from Dentists, Physical Therapists, Pharmacists etc through primary care and Specialist Headache clinicians.

1. Understand that management is more than suggesting a few tablets
2. Identify a wide range of factors that can contribute to a presentation, and understand that bespoke management is most likely to succeed
3. Recognise patients present to a wide range of community based professionals, all of whom can assist in some way and at some times, but the challenge is to have the right patient with the right professional(s) at the right time.
4. Accept that patients┬┐ needs may change over time.

Co-morbidities of Headache

This section describes the different illnesses that are associated with migraine: co-morbidities. A large number of illnesses have been linked to migraine at varying times, many of them with little objective evidence. This course describes the illnesses where a link with migraine is supported by clinical evidence; the main ones being psychiatric disorders, stroke and other cardiovascular disorders and epilepsy. It also examines the underlying mechanisms that may explain the co-morbidities and the clinical implications that result from them.

1. Discuss known comorbidities associated with migraine and other headache disorders
2. Understand appropriate treatments for headache and associated comorbidities

Managing Chronic Migraine

Migraine affects about 15% of the population. According to WHO, it is the 6th highest lifetime disability and is ranked between schizophrenia and paraplegia. Most sufferers start off with episodic migraine with an average of 1 attack per month lasting 4-72 hours. However, at some point, 1 in 6 of these patients evolve to the chronic form of migraine. It is defined as headache occurring at least 15 days a month of which at least 8 days have migraine features or migraine specific medication for three consecutive months. Patients move between the 2 groups and hence there is an intermediary group of high frequency episodic migraine who are at greater risk of developing chronic migraine. For this group, and those with chronic migraine, the issue of medication overuse cannot be overstated or underestimated.

Management of chronic migraine requires attention to medication overuse as well as a rational approach to rescue medication and understanding the range of preventative options. Nutraceuticals can be used as well as some medical devices. Addressing the comorbidities can be crucial, and for those refractory to treatment, Botox and monoclonal antibodies are now available. There are other treatment options in the pipeline.

1. Diagnose chronic migraine in clinic
2. Understand the impact of the disease on an individual and society
3. Be able to identify and advise on medication overuse headache.
4. Have an understanding of the treatment options available including Botox and monoclonal antibodies for those refractory individuals
Entry Requirements (not applicable to Visiting Students)
Pre-requisites It is RECOMMENDED that students have passed Pain - A Multidimensional Phenomenon (PAMA11067) AND Assessment, Measurement and the Multidisciplinary Approach (PAMA11054) AND Neuroanatomy and Neurophysiology and its Relevance to Pain Management (PAMA11055) AND Understanding the Pharmacological Management of Pain (PAMA11068) AND Non-Pharmacological Approaches to Pain Management (PAMA11057) AND Introduction to Pain Management in Practice (PAMA11070)
Co-requisites
Prohibited Combinations Other requirements None
Information for Visiting Students
Pre-requisitesThe minimum entry requirement is a UK 2:1 undergraduate degree, or its international equivalent.

Relevant disciplines include: medicine; nursing; dentistry; psychology; occupational therapy; physiotherapy; pharmacology; osteopathy; other allied health care profession involved in the management of pain.

Applications from those with non-university professional qualifications such as RGN with appropriate clinical experience will be considered on an individual basis.

Where applicable, you will also be required to meet any language requirements in accordance with the University's regulations.
High Demand Course? Yes
Course Delivery Information
Academic year 2022/23, Not available to visiting students (SS1) Quota:  None
Course Start Flexible
Course Start Date 08/08/2022
Timetable Timetable
Learning and Teaching activities (Further Info) Total Hours: 200 ( Lecture Hours 40, Online Activities 30, Formative Assessment Hours 20, Summative Assessment Hours 40, Revision Session Hours 30, Programme Level Learning and Teaching Hours 4, Directed Learning and Independent Learning Hours 36 )
Assessment (Further Info) Written Exam 0 %, Coursework 100 %, Practical Exam 0 %
Additional Information (Assessment) 100% fully online coursework
Feedback Feedback consists of ongoing support provided by course tutors; individual, group and ongoing group feedback.
Summative marks will be provided on a published timetable and students will be provided with electronic written feedback for all coursework submitted.
No Exam Information
Learning Outcomes
On completion of this course, the student will be able to:
  1. Understand and discuss with other healthcare professionals and patients the prevalence of headache types, the direct and indirect costs of headache, and act as an advocate for sufferers who require better services and better support and understanding across work, chores and social activities, as well as from social care.
  2. Demonstrate a critical undertraining and recognition of the common primary and secondary headache disorders and be able to formulate, and discuss as part of an interprofessional student group, the rationale for patient-centred management.
  3. Utilise evidence-based diagnosis and management tools to quickly identify different headache subtypes and recognise the features of episodic and chronic headaches according to internationally accepted guidelines.
  4. Apply methods to understand the evidence in clinical trials and how the evidence affects guidelines, treatment options, and personal practice in primary care that recognises and identifies a wide range of factors that can contribute to a presentation, and understand that bespoke management is most likely to succeed.
  5. Develop and apply skills related to academia, professional reflection and critical analysis of the literature, to evaluate current practices in headache management and continue to use these skills as a lifelong learner.
Reading List
ICHD-III Classification.
Additional Information
Graduate Attributes and Skills During the course students will have to demonstrate the ability to work both independently and collaboratively with others. Their knowledge and understanding of the topic will improve but they will also learn generic approaches/skills. As the course is distance learning, it will contribute to their IT, writing and communication skills which can be applied to both clinical and academic environments. Finally, they will be expected to be able to bring together and draw from the information provided through the course during their assignment writing. Competences such as structuring of work and accurate referencing should also improve.
KeywordsHeadache,migraine,tension-type,neurology,medicine,primary care
Contacts
Course organiserDr Christopher McKenzie
Tel: 0131 242 6130
Email: Christopher.McKenzie@ed.ac.uk
Course secretaryMs Ewelina Skala
Tel: (0131 5)37 1000
Email: eskala2@exseed.ed.ac.uk
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