The number of neurologists with a subspecialty in headache medicine jumped by 66 percent since 2012, but many more are still needed, particularly in underserved areas, according to a paper presented at the American Headache Society annual scientific meeting.

The absolute number of headache subspecialists grew from 416 in 2012 to 692 in December 2021, reported Skyler S. Kanegi, a fourth-year medical student at UT Health Antonio’s Long School of Medicine and first author of the paper. By comparison, the expected population of adults with headache disorders was estimated to have grown by only 5.4 percent, he said.

Seven states lost subspecialists, and three—Alaska, Montana, and Wyoming—still have none, Kanegi reported. But overall, the national trends were generally positive.

“North Dakota, Delaware, and South Carolina gained their first headache subspecialists,” Kanegi said. “The South had the highest absolute increase in subspecialists, with 99 additional providers, while the West had the highest relative increase, at 105 percent.”

But gains were not correlated with the expected headache burden. Instead, the density of subspecialists correlated with the states’ average personal income. Even so, the pace of growth in the number of subspecialists correlated with tne poverty rate.

“Some of the highest growth in headache subspecialists has been in the states (Mississippi and Kentucky) and regions (South and West) with the least access in 2012,” Mr. Kanegi reported. Kanegi collaborated on the research with senior author Noah L. Rosen, MD, FAHS, program director for neurology and associate professor of neurology and psychiatry at the Zucker School of Medicine at Hofstra Northwell Health in Great Neck, NY, and system director of headache medicine .​​

​”The Graduate Medical Education Subcommittee of the AAN has begun to address some of these issues by creating a more standardized process for fellowship training across neurology,” Dr. Rosen said. “This allows residents to better appreciate the options available to them and how further training in headache medicine can be obtained. Additionally, advocacy initiatives by the AAN including Neurology on the Hill have supported governmental funding for additional residency spots to try to support more training in our field.”

Similar to a study Dr. Roses published in headache in 2014, he, Kanegi, and colleagues analyzed data from the United Council of Neurologic Subspecialties, the National Health Interview Survey, the US Census, the Bureau of Economic Analysis, and the American Community Survey. They then performed univariate and multivariate regressions to assess the potential contributing factors to the trends they observed.

They found that Vermont and Connecticut had the highest density of subspecialists after adjusting for expected adult headache disorder​ population.

“By region, the Northeast and Midwest continue to have higher subspecialty density compared with the South and West,” Mr. Kanegi reported. “The highest absolute subspecialist increase was in California and Texas, and the highest relative subspecialist increase was 500 percent in Vermont and Mississippi.”

“The growth in states with higher poverty rates is promising and encouraging,” Kanegi said, adding, “There is still much to be done to decrease geographic disparities in access to headache subspecialists.”

Commenting on the study, Amaal J. Starling, MD, FAAN, associate professor of neurology at the Mayo Clinic in Scottsdale, AZ, said although there has been an increase in headache medicine subspecialists, there is still a significant unmet need. “Headache clinics still have significant wait lists and patients enounter delays in care to the lack of enough headache specialists,” said Dr. Starling, who was not involved with the study.

Randolph W. Evans, MD, FAAN, a clinical professor of neurology at Baylor College of Medicine, agreed. “Although it is encouraging to see the significant increase in the number of headache subspecialists, 692 is clearly not close to enough,” he said.

dr Evans added, however, that he expects the number of headache subspecialists to continue to rise.

“The key is to continue to expand the excellent educational programs of the AAN, American Headache Society, National Headache Foundation, and other groups, and to and encourage medical schools and residency programs to increase their headache medicine education. Hopefully, the introduction of new treatments that block CGRP in the last four years is generating interest and enthusiasm in migraine and perhaps headache medicine.”

Kanegi had no disclosures. dr Rosen disclosed that he has received honoraria for work on advisory boards for Abbvie, Eli Lilly, Biohaven, and Lundbeck and on a speaker panel for Abbvie. He has received honoraria as a section editor for Current Pain and Headache Reportsserves on the board of directors of the AHS, and recently completed his term on the board of directors of the United Council of Neurologic Subspecialties.

Link Up for More Information

AHS LBOR-01: Kanegi SL, Rosen NL. Ahead of the pain: Where we stand after a decade of growth in headache subspecialists.

Masuer ED, Rosen NL. So many migraines, so few subspecialists: Analysis of the geographic location of United Council for Neurologic Subspecialties (UCNS) certified headache subspecialists compared to United States headache demographics. Headache 2014;54(8):1347-1357.​

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