Headache Interest in Academic Neurology Leadership: A Cross‐Sectional Study

Abstract

Background.-Headache disorders are exceedingly common, debilitating neurological conditions, and there is a striking paucity of headache specialists nationally. However, headache education is underrepresented in the curriculum of neurology residency programs and few neurology residents elect to pursue headache medicine fellowships. We aimed to explore the possibility that a low degree of headache interest among neurology department chairs and residency program directors (PDs) underlies this mismatch.Methods.-We performed a cross-sectional analysis of chairs and PDs associated with ACGME neurology residency programs. Data sources included the ACGME program list, faculty profiles on institutional webpages, Doximity profiles, the American Headache Society (AHS) membership directory, and the roster of United Council for Neurologic Specialties (UCNS) headache diplomates. A headache interest was deemed to be present with the presence of a declared headache or concussion interest, completion of a headache fellowship, active AHS membership, or UCNS certification.Results.-Our review included 137 residency programs comprising 127 department chairs, 132 PDs, and 5 faculty who were both chairs and PDs. Of all faculty, 62 (23.5%) were women. Headache expertise was declared by 10 (7.6%) chairs and 13 (9.5%) PDs. Headache fellowship training was pursued by 1 (0.8%) chair and 5 (3.6%) PDs, and among all faculty was the 10th most common subspecialty fellowship pursued. Three (2.3%) chairs and 7 (5.1%) PDs were AHS members. Seven (5.3%) chairs and 10 (7.3%) PDs were UCNS headache certified. An overall headache interest was present in 29 (11.0%) faculty, including 14 (10.6%) chairs and 15 (10.9%) PDs. A graduate degree aside from an MD (eg, PhD, MPH) was more likely to be achieved in faculty without a headache interest (29.4%) than faculty with a headache interest (6.9%, P 5 .0076). Residency programs where either the chair or PD had a headache interest were just as likely to feature a UCNS headache fellowship program than programs without chair or PD headache interest (25.0 vs 23.0%, P 5 .83).Conclusions.-Current neurology department chairs and residency PDs have low rates of headache interest, which may influence the emphasis of headache education in neurology training. Headache interest is associated with lower rates of other graduate degrees, and future analysis should examine if academic faculty interested in headache are less likely to be in leadership positions because of a lack of research funding, opportunities, or accomplishments.

Grand rounds education in neurology, with a focus on headache medicine

“…Another possible reason for the underrepresentation of headache medicine is the quantity of headache specialists in the United States. The low numbers of overall headache specialists, as well as the low numbers of headache specialists at the department chair and program director positions, 18 might also lead to a de‐emphasis in grand rounds. Grand rounds are an opportunity for faculty to present to their department; thus, fewer headache faculty may mean fewer headache lectures.…”

“You will eat shoe polish if you think it would help”—Familiar and lesser‐known themes identified from mixed‐methods analysis of a cluster headache survey

“…5,11 Knowledge about oxygen therapy, access to it, and proper instruction on its use are lacking for many, however. education, 13,14 the odds are stacked against patients for the immediate initiation of appropriate and successful treatment.…”

The unmet need of headache medicine grand rounds education in neurology

“…The authors suggest that a major reason for the underrepresentation of headache medicine in grand rounds series may be related to the fact that there are fewer headache specialists on faculty relative to other subspecialties and fewer headache specialists at the department chair and program director level. 8 Headache medicine education, therefore, is expected to occur in other formats, such as resident lecture series, subspecialty clinics, and electives. Despite this expectation, many program directors feel that headache medicine educational experiences in their residency program are inadequate.…”