Severe headache since yesterday
PLAB 2 practice station

The task

You are a doctor in a GP surgery. Mr Daniel Okafor, aged 52, has booked an urgent appointment because of a headache that began yesterday. He is alone. Take a focused history. Then explain to him what you think needs to happen next and why, answering his questions, and tell him what to do if things change. There is no need to examine him. The examiner will not take part in the conversation.

What this station tests

• Thunderclap onset, neck stiffness and vomiting need same-day hospital assessment, not a painkiller prescription.
• Ask the family history: sudden death or brain bleed in a relative raises concern.
• Say clearly why you are worried, without claiming a diagnosis you cannot yet confirm.
• Do not let a patient with red flags drive himself; arrange an ambulance and a person to stay with him.
• Safety-net specific changes and check his understanding in his own words.

Sources for the clinical content

• NICE CG150: Headaches in over 12s: diagnosis and management
• NICE NG228: Subarachnoid haemorrhage caused by a ruptured aneurysm

An original practice scenario with invented patients. Not an exam question.

Practise next

• Chest tightness that comes and goes
• Breathlessness and cough in a long-term smoker
• Lower abdominal pain in a young woman
• Low mood and poor sleep
• Weight loss and a change in bowel habit