BOSTON, Massachusetts — As patients with headache living in Alaska, Delaware, Montana, North Dakota, South Carolina, and Wyoming probably already know, there's not a single certified headache specialist practicing anywhere in those states.
The picture is brighter, however, in Washington, DC, New Hampshire, New York, and Nebraska, which have much higher rates of headache specialists.
Noah Rosen, MD, director, Headache Center, Cushing Neuroscience Institute, New York, hopes that his new study, which uncovered specialist shortages across the United States, will highlight the problem of lack of funding for training programs. "We need more recognition for a condition that's more common than asthma and diabetes combined."
The study will presented here during the 2013 International Headache Congress (IHC).
Disease of Morbidity
Migraine affects 11.8% of the general US population aged 12 years and up. That translates into 30.6 million patients with migraine and 2.4 million with chronic migraine.
For the study, Dr. Rosen and his colleagues located all United Council of Neurologic Subspecialties (UCNS) headache specialists geographically and compared that information to demographic data on state populations.
As of 2012, there were 416 UCNS headache specialists practicing in the United States. Six states had no headache specialists at all, while 8 had only 1 and 5 had only 2.
The shortage problem, which appears to be rooted in a lack of government-funded training programs that has resulted in an "extremely limited number of fellowship positions," said Dr. Rosen, could get even worse as experts predict a future physician shortage.
"Neurologists in particular will have an even greater percentage of the expected shortage in the next 10 years, and given the few fellowship training programs that allow people to be trained in headache, there will be even a greater shortage of headache specialists."
The underfunding seems to be accompanied by what Dr. Rosen called a "bias of misperception" against migraine sufferers and is certainly not helped by the fact that the World Health Organization (WHO) has listed migraine among the top costs of disability worldwide, said Dr. Rosen.
"Migraine is perceived as a disorder of morbidity not necessarily of mortality and there has been significant underfunding because of that."
The fallout has been that medical graduates who are keen to specialize in headache are being turned away, said Dr. Rosen, who is also residency director in neurology. "I have had residents interested in the field, but since there are only 2 to 3 positions available in New York for training, they decided not to go into it."
For the general headache population, the shortage may not make much of a difference, but for those with chronic headaches it may be a problem, said Dr. Rosen. "Those are people who often fail typical treatments and would benefit from the experience that a headache specialist would offer."
Dr. Rosen has disclosed no relevant financial relationships.
International Headache Congress (IHC) 2013. Abstract P201.
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Cite this: Many States Have No Headache Specialists - Medscape - Jun 26, 2013.