Only 416 physicians in the U.S. are certified headache specialists, meaning there is just one for every 73,661 migraine sufferers, researchers reported here.

With an estimated migraine population in the U.S. of some 31 million - of whom about 2.4 million have chronic forms and the greatest need of specialist care - many patients have no effective access to these professionals, according to Noah Rosen, MD, of North Shore-Long Island Jewish Health System in Manhasset, N.Y.

Six states have no certified headache specialists and eight others have only one, Rosen reported at the International Headache Congress.

Many of these states are only lightly populated, such as Alaska, Wyoming, and Vermont. But the list of states with zero or one headache specialist also includes several with overall populations of 2 million or more, including Oregon, Kansas, Mississippi, and Arkansas.

Rosen said that too few physicians receive training in headache management, given the scale of the public health problem that migraine and other severe headaches represent. He noted that the U.S. currently has only 23 fellowship programs in headache medicine.

Moreover, he said, many physicians who are qualified to receive the formal certification haven’t sought it, probably for reasons of cost, time, and uncertainty about its value.

The study, conducted by Rosen and Emily Mauser, an undergraduate at Hofstra University in Hempstead, N.Y., analyzed the geographic locations of physicians certified in headache medicine in 2012 by the United Council of Neurologic Specialties (UCNS), along with prevalence estimates of overall migraine and chronic migraine in each of the 50 states and the District of Columbia.

Those estimates were based on a national prevalence of 11.79% in the general population, 12 and older, for overall migraine and 0.91% for chronic migraine, which had been established in a nationwide study published last year.

Rosen and Mauser found a wide variation among states in the ratio of the estimated migraine population to the number of headache specialists. These ratios varied by 10-fold, even leaving out the states with no headache specialists (for which the ratio would be infinity).

For overall migraine, the ratio ranged from a low of about 31,000 in the District of Columbia (with two headache specialists) to 384,000 in Oregon (also with two).

States with the most specialists were mostly those with the highest populations, including California, New York, Florida, Texas, and Pennsylvania. However, even in these states, the ratios of migraine sufferers to specialists varied considerably, from about 35,000 in New York to 127,000 in California.

For chronic migraine, even the states with the lowest ratios would still leave the available headache specialists stretched thin. In the District of Columbia, with an estimated 4,850 chronic migraineurs, the two specialists would each have a theoretical caseload of 2,425 patients.

Stephen Landy, MD, of the University of Tennessee Medical School in Memphis, who was not involved with the study, said the findings were both disturbing and revealing, particularly with respect to chronic migraine.

He said those patients are the ones most in need of specialist care. In actual practice, most such patients are being treated by primary care physicians or general neurologists. “Many aren’t being treated appropriately,” he said.

Rosen said that migraine care is not restricted to family practice, internal medicine, and neurology practitioners. A significant number of patients receive their treatment from ob/gyn physicians and ophthalmologists.

As with most subspecialties, certification in headache medicine is awarded to physicians completing a special fellowship and passing an exam. However, a temporary pathway has been established by the UCNS for experienced physicians to be certified simply by taking the exam. That pathway will end next year.

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Primary source: International Headache Congress
Source reference: Rosen N, et al. “So many migraines, so few specialists: analysis of the geographic location of United Council for Neurologic Subspecialties (UCNS) certified headache specialists compared to USA headache demographics” Cephalalgia 2013;33(supplement):146-47.