Secondary Headache: Learning Diagnostic Reasoning in Complex Cases

Required reading for all learners: Implicit Bias impacts patient outcomes

The purpose of this article is to review the diagnostic thought process required of ACNPs, provide a case-based example of DR in a complex secondary headache scenario, and identify key tools to help ACNP learners develop strong DR skills. Multiple strategies for developing or advancing DR competencies can be used by ACNP learners at all levels using learner-driven approaches. Statistically significant improvement in DR performance can be achieved with intentional, learner-driven activities and metacognitive exercises. ACNP learners have the opportunity to master DR using various type 1, type 2, and metacognitive processes to ensure safe and effective DR, even in the most complex of cases. The topics include the process of diagnostic reasoning, use of likelihood ratios, the SNOOP10 criteria for secondary headaches, and a discussion of the general approach to evaluation of red flag signs commonly found with dangerous headaches.