According to the American Headache Society, almost 37 million Americans live with some form of headache disorder, so you’d think there would be a relatively large number of specialists to treat them. However, there are only about 550 headache specialists in the US as a whole. Why is there such a discrepancy?
Headache medicine in medical school
Unfortunately, the problem lies with students’ medical training. First, there’s no standardized curriculum for headache medicine, and so education about it varies tremendously from one school to another.
Second, during their entire four years of medical school, students spend less than a couple of hours dedicated to learning about headache medicine, despite the high prevalence of headache disorders.
And third, patients with headache disorders are most often seen and treated in primary care settings, pediatrics, OB/GYN, emergency rooms, and a number of other specialties. But there aren’t enough students in these fields, even neurology, receiving the training they need to appropriately recognize and treat headache disorders.
In most cases, students aren’t even exposed to headache disorders until they reach clinical care, which, historically, begins toward the third or fourth year of medical school.
Changing direction
According to Dr. Noah Rosen, a fellow of the American Headache Society, many newer institutions are beginning to incorporate clinical care from day one. As he fell into this latter category, seeing patients with severe headache disorders coming into the ER every day led him to become interested in headache medicine, and that helped shape his career.
But he didn’t learn about headache until the customary third year. He comments, “It would’ve been very helpful to know more about the field when I was trying to care for patients.”
He also believes it’s important to have a standard curriculum for the subject across all medical schools, one that incorporates the latest science, pathology, physiology, and demographics of headache care, as well as up-to-date information about current treatments. And it’s not just important for students studying to be headache specialists, but also for students of all other specialties, to have this exposure.
Obstacles and a way forward
There are systemic problems that hinder expanding the headache medicine field. Both residency and fellowship programs have been capped since 1997; the government won’t provide any additional funding to help support those programs. Institutions also have caps on the number of trainees they can accept, which has prevented fields like neurology and headache medicine from expanding.
As a result, the importance of headache medicine has been underrecognized, and patients severely underserved. This is changing, though, as more determined specialists have provided mentorship to train more professionals. And as technology improves, specialists have been better able to spread the word about headache disorders and the ways to manage these conditions through recognition, education, and further specialization.
While many medical schools have associated headache specialists, not all do. But even if there aren’t mentors available at a specific institution, there’s a thriving online community through the American Headache Society, whose expertise students can use to expand their knowledge and careers.