Medicine — Referral to Neurology for Migraine
A doctor refers a 29-year-old woman with worsening migraine to neurology after first-line treatment fails. This is a beginner case: one clear problem, few distractors, and a short set of notes. The skill it builds is structure and purpose, not complex selection.
Letter type
Referral
Write to
Neurologist
Target length
180–200 words
The case notes
Patient: Ms Hana Farouk, 29 years old, accountant
Presenting complaint: 12-month history of migraine; now 3–4 attacks per month, each lasting up to a day
Features: Unilateral throbbing headache, nausea, photophobia; preceded by visual aura
Impact: Missing 2–3 work days a month; sleep and concentration affected
Treatment tried: Sumatriptan and regular analgesia; only partial relief; propranolol prophylaxis tried, not tolerated
Examination: Normal neurological examination; BP 118/76; no red-flag features
Medical history: Nil significant; non-smoker
Task: Write a referral letter to Dr Sayed, Neurologist, requesting assessment and advice on further migraine management.
Writing task
Write a referral letter to Dr Sayed, Neurologist, requesting assessment and advice on further migraine management.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
-
The migraine pattern: frequency, duration and aura
This is the core clinical picture the neurologist needs; it defines the problem being referred.
-
Treatments already tried and their outcome
Tells the recipient what has failed, so they do not repeat first-line steps. The reason for referral is incomplete control.
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Normal examination and absence of red flags
Reassures the neurologist this is a management referral, not an emergency, and shapes urgency.
Leave out
-
Occupation beyond its impact
Mention the missed work as functional impact; the job title itself is not decision-relevant.
-
Routine normal observations in detail
A single line that examination was normal is enough; listing every value pads the letter.
Criterion in focus · Purpose
Beginner cases are the place to master Purpose: state who the patient is, the single problem, and exactly what you want from the recipient in the opening. With few distractors, there is no excuse for a buried purpose.
Now write the letter — and find out what is blocking your Grade B
Write a 180–200 words referral letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.