Barriers and Gaps in Headache Education: A National Cross-sectional Survey of Neurology Residents in Denmark

Abstract

Background: A major barrier to adequate headache care is lacking formal education and training of healthcare professionals. Concerted efforts should be made to pinpoint major gaps in knowledge in healthcare professionals to facilitate better educational policies in headache training. The aim of this study was to identify deficiencies and barriers in headache training among residents in neurology in Denmark.Methods: We conducted a national cross-sectional survey of residents in neurology in Denmark from April 2019 to September 2019. The survey included questions on participant demographics, knowledge of and barriers in headache disorders, guidelines and diagnostic tools usage, contact with primary and tertiary care, medication overuse, and non-pharmacological interventions.Results: Sixty residents across Denmark accepted the invitation and 54/60 (90%) completed the survey. Although two-thirds, 35/54 (65%), of the population had prior formalized training in headache disorders, we identified gaps in all explored domains including diagnosis, management, and referral patterns. Particularly, there was an inconsistent use of guidelines and diagnostic criteria from the Danish Headache Society (2.74 (±1.14)), the Danish Neurological Society (3.15 (±0.86)), and the International Classification of Headache Disorders (2.33 (±1.08)); 1: never/have not heard of, 4: always. Headache was ranked second to last out of six sub-specializations in popularity.Conclusions: Overall knowledge on headache disorders amongst neurology residents in Denmark do not meet the expectations set out by national and international recommendations. Stakeholders should make strategic initiatives for structured education in headache for improved clinical outcomes in parallel with costs reduction through resource optimization.

Treatment experiences and clinical characteristics in migraine and tension-type headache patients before the first visit to a tertiary headache center

“…The improper medical treatment of headache may lead to a significant risk of MOH especially in migraine patients (28). Indeed, a recent national cross-sectional survey of residents in neurology in Denmark showed that overall knowledge of neurology residents on headache disorders do not meet the expectations set out by both national and international recommendations (29). The study identified several deficiencies and barriers in headache management amongst residents particularly related to diagnosis.…”

“…Even though there are eight tertiary headache centers in Denmark today and more pharmacological options than 30 years ago, there is obviously a need for improved headache care in Denmark. Structured education in headache and other strategic initiatives at all treatment levels should be prioritized by both regional and national stakeholders (29). Headache care is possible to improve in Denmark through education and awareness.…”

Interest in and exposure to headache disorders among neurology residents in Denmark: A nationwide cross‐sectional survey

“…3 Denmark is considered to have one of the longest traditions of headache care in the world, but even here, barriers and gaps in headache education are identified among residents in neurology with several of these being at a structural level. 4 These challenges are most likely structural. Indeed, residents are expected to acquire expertise about headache disorders through clinical experience and self-study without any dedicated or formalized requirement of hours in specialist outpatient clinics, 5 which allows for knowledge and experience gaps during fundamental training years.…”

“…Denmark is considered to have one of the longest traditions of headache care in the world, but even here, barriers and gaps in headache education are identified among residents in neurology with several of these being at a structural level 4 . These challenges are most likely structural.…”