Introduction and Goals
This rotation is a clinical experience elective that can be taken at any time. The minimum duration of this elective is 1 week, although 2-4 weeks is preferred.
For PGY-2 residents who choose this elective, the primary educational goal is to provide exposure to various headache and pain syndromes and appropriate pharmacological strategies as well as exposure to procedure-based management techniques.
For PGY-3-4 residents, the goal is to develop competence in managing complex headache disorders, including the performance of procedure-based techniques.
Objectives and Evaluation Matrix
As with all of the neurology rotations, the specific objectives are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the end-of-rotation evaluation. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).
| Rotation Objectives | ||
| Upon completion of the curriculum, residents will . . . | ||
| # | Description | Milestones |
| 1 | Identify red flags in the history and exam suggestive of a secondary headache disorder | PC1, PC2, PC3, PC4, PC6, MK1 |
| 2 | Classify primary headache disorders as belonging to the migraine, tension-type, or cluster and other trigeminal autonomic cephalalgia categories | PC1, PC2, PC3, MK1 |
| 3 | Appropriately prescribe abortive therapy for migraine | PC3, PC4 |
| 4 | Institute prophylactic therapy for migraine, including vitamins and supplements, when indicated | PC3, PC4 |
| 5 | Select appropriate patients for interventional treatments such as nerve blocks and botulinum toxin injections | PC1, PC2, PC3, PC4 |
| 6 | Implement rescue therapy for patients with status migrainosis | PC3, PC4 |
| 7 | Educate and counsel patients with chronic migraine and medication overuse headache and negotiate conflicts regarding their medication management | PR1, IC1 |
| 8 | Describe unique concerns related to women with headaches, including menstruation related headaches, role of birth control in headache management, and headache in pregnancy | PC4 |
| Milestones | ||
| Please grade the resident on any of the following milestones you were able to evaluate during this rotation: | ||
| SP3, SP4, PL1, PL2, PR2, PR3, IC2, IC3, IC4 | ||
Schedule
Below is a sample schedule for this rotation, including a combination of clinic time with Headache attendings as well as clinics with APPs to learn technique for office-based procedural injections (Botox, trigger points, nerve blocks). This schedule is subject to attending availability; accordingly, this elective may not be able to be offered during weeks when multiple attendings are out of clinic (for example, national conference weeks or holidays).
The below schedule can, within certain parameters, be adjusted to address specific resident learning goals for the rotation. If there are specific requests for scheduling, these should be included in the elective request form and sent to the Program Coordinators. An individualized schedule will be emailed to the resident the week before the rotation.
| Monday | Tuesday | Wednesday | Thursday | Friday | |
| AM | Headache | Headache | Headache | Headache | Headache |
| UW | UW/ 20 S Park | UW | Reading/Admin | APP Procedures | |
| PM | Headache | Headache | Headache | Headache | Headache |
| UW | UW/ 20 S Park | UW | Continuity Clinic | Reading/Admin |
Work Hours
There are no call or weekend responsibilities during this rotation. The total hours per week at this clinic is expected to be 32.
Suggested References
International Headache Society Classification website: The International Classification of Headache Disorders – ICHD-3
Continuum. Headache, Volume 27, Issue 3, June 2021
Lipton, R. B., Silberstein, S. D., & Dalessio, D. J. (2001). Wolff’s headache and other pain. New York; Oxford: Oxford University Press.
Silberstein, S. D., Lipton, R. B., & Goadsby, P. J. (2002). Headache in clinical practice. London; New York; Florence, KY: Martin Dunitz ; Distributed in the USA by Taylor & Francis.
Latest revision: 06-01-2023
