The Workforce Gap in Headache Medicine

Commentary published in Headache®️ highlights physician shortage ahead of Headache on the Hill

Few physicians receive adequate training to effectively diagnose and treat migraine, argue the authors of a new commentary in Headache®️ about the U.S. workforce gap in the field of headache medicine. Most medical schools lack a curriculum in headache medicine, while most of the primary care physicians who provide first-line headache evaluation and treatment recommendations never receive formal training in this area either. “While neurologists are the specialists most likely to care for patients with headache disorders, their training in this field is often inadequate,” the authors write.

This lack of expertise can result in the mismanagement of headache disorders, leading to a significant societal burden. The optimal management of headache disorders is associated with decreased disability, increased work productivity and improved quality of life for people with headache. However, there are only 1.2 headache medicine physicians per 100,000 people with migraine in the U.S.

“As headache specialists, we knew there was a shortage because patients wait for months and drive long hours to come see us,” says Olivia Begasse de Dhaem, MD, headache medicine fellow at the Harvard University Graham Headache Center and Mass General Hospital and lead author of the paper. “The shortage is blatantly apparent.”

The purpose of the paper was to calculate an estimation of the headache medicine workforce needs, which helps advocate for funding to train the appropriate number of headache medicine specialists. “People in D.C. need actual data; they need an actual quantifiable problem and a clear solution,” Dr. Begasse de Dhaem says.

Results and assessment

The study estimates a need of 3,700 headache medicine specialists to care for those most affected by migraine in the U.S. That number takes into account the current prevalence of migraine in the population and patterns of healthcare utilization; but it does not include other disabling headache disorders. The projected need of headache medicine specialists in 2040 is about 4,500, accounting for population growth. Therefore, the study recommends at least 100 federally funded Headache Medicine fellowship spots per year to fill the gap.

Working toward a better future

The commentary was published ahead of Headache on the Hill, an annual legislative advocacy event that brings patients, providers and researchers to Capitol Hill to request more funding for headache and migraine treatment and research in addition to increased access to care.

While Washington acknowledges the current opioid and chronic pain crisis in the U.S. Opioid Workforce Act, with bipartisan bills to fund 1,000 new physician training spots in addiction medicine, addiction psychiatry and pain medicine. Doctors trained in pain medicine fellowships usually do not take care of people with headache disorders. Headache medicine fellowships specifically train physicians to take care of people with headache disorders. “Currently the Opioid Workforce Act bill is in the Health and Commerce Subcommittee on the Congress side and in the Finance Committee of Jurisdiction on the Senate side,” Dr. Begasse de Dhaem says. The 2020 requests from Headache on the Hill were for Congress to co-sponsor the bill and to increase funding for Headache Medicine fellowships in addition to pain medicine fellowships.

In addition to continued advocacy, Dr. Begasse de Dhaem says that future analysis should include a nationwide survey of people with headache disorders, “to ask them about their experiences getting care, satisfaction with primary and emergency headache disorder care and difficulties getting an appointment with a headache medicine specialist.”

Headache®: The Journal of Head and Face Pain is the official journal of the American Headache Society. AHS frequently reviews published research and provides commentary on the work being done to help advance the understanding of headache and face pain. For more analysis on studies published in Headache®, visit the AHS News page.