SCA practice case · Telephone consultation
“Zigzag lights, then the headache”
Telephone consultation
Adult patient
Straightforward
Gender, reproductive & sexual healthNew & undifferentiated presentations
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Robyn Carter · 31 years · female
Setting
Telephone — new visual symptoms with headache, on the COC.
Past history
- Menorrhagia and dysmenorrhoea
- Migraine without aura (adolescence)
Medication
- Rigevidon 1 tablet daily (6 years)
Allergies
None recorded
Recent notes
BMI 24. On Rigevidon for 6 years. Smoking status on record: ex-smoker.
Reason for contact
Telephone call. “I need something stronger for these headaches.”
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
Migraine WITH aura is the single most important contraception-safety flag in general practice: combined with an oestrogen-containing pill it substantially raises ischaemic stroke risk and is a UKMEC 4 (absolute) contraindication — the combined pill must stop. The classic exam trap is to hear "worse headaches, wants stronger painkillers" and miss that the visual aura changes everything. But stopping the pill is only half the task: the examinable skill is NOT leaving her exposed — arrange a safe alternative (POP, implant, injection, IUS) promptly, and address the period problem the pill was treating (the IUS is ideal). Here the hidden agenda is a wedding in 7 weeks and terror of unplanned pregnancy / ruined honeymoon, so frame the switch as protecting the wedding. Treat the migraine (NICE CG150: triptan with an NSAID or paracetamol + antiemetic, diary, prophylaxis if frequent — not topiramate as a first choice for a woman who may want a pregnancy, MHRA June 2024), ask about smoking (a compounding oestrogen-stroke risk) non-judgementally and offer stop-smoking support (NICE NG209), and safety-net for stroke. Migraine WITHOUT aura (her teenage pattern) does not carry the same absolute restriction; check its current category in the UKMEC 2025 table rather than quoting one from memory.
The guidance behind it
Similar SCA cases
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