On Making a Headache Medicine Rotation Mandatory in Neurology Training

INTRODUCTION According to the World Health Organization, headache disorders are the most common disorders of the nervous system. It is also generally accepted that headache is the most common chief complaint in neurology clinical practice. Regardless of whether a trainee elects to sub-specialize or to enter general practice, it is essential for every neurologist to have a solid foundation in headache medicine. There are only a small proportion of neurology residency programs in the country that have a mandatory headache rotation for their adult neurology residents. In a 2016 crosssectional study assessing the status of headache didac tics and clinical training in 133 adult neurology residency programs in the United States, it was found that 19 programs (26% of the 72 programs that responded) had a mandatory headache rotation as a graduation requirement for neurology residents. In our residency program, adult neurology PGY-2 residents spend 1 half day of clinic each week in headache clinic, during their 2-4 weeks of sub-specialty clinic rotation. Headache faculty perceived a knowledge gap in procedural training and the ability of residents to diagnose and manage uncommon headache disorders. According to the ACGME Neurology Milestone project, level 4 in the headache milestones corresponds with the ability of a resident to “diagnose and manage uncommon headache syndromes” and is the target for graduation. Yet, there was confidence among residents that they already knew what they needed to know about headache management, despite the lack of general awareness of the actual diagnostic criteria and treatment options for even the most common primary headache disorders. It was clear that there was a need for better, more formalized headache education. In 2017, we worked to convince our department’s education committee to establish a mandatory headache rotation for all adult neurology residents. Headache doi: 10.1111/head.13667 © 2019 American Headache Society Published by Wiley Periodicals, Inc. ISSN 0017-8748