Headache Education in Adult Neurology Residency: A Survey of Program Directors and Chief Residents.

Objective: This cross-sectional study reassesses the status of headache didactics and clinical training in adult neurology residency programs in the United States to determine if program directors and chief residents feel that current training in headache is adequate.

Background: Headache is among the most common new complaints to both the neurology and primary care clinic and represents a significant economic burden. However, headache remains both under-diagnosed and under-treated. Of those who seek treatment only 28% report they are very satisfied with their management. One possible cause for dissatisfaction is inadequate education of treating physicians. Two studies in 2002 and 2005 that collectively surveyed all 125 adult neurology residency programs concluded that more evidence was needed to evaluate the adequacy of headache education in these programs. A survey of neurology residency department chairs and program directors in 2005 also evaluated the status of headache education in adult neurology training programs and concluded the same.

Methods: We surveyed 133 neurology residency program directors and 213 chief residents. Program directors and chief residents were asked about the amount of headache didactics, amount of clinical exposure to headache, perceived adequacy of current training and if plans existed to increase headache education through didactics or clinical exposure.

Results: Seventy-two program directors (54%) and 117 chief residents (55%) responded. Twenty-six percent of programs reported a mandatory headache clinic. Of these, 35% of programs reported <2 weeks of clinic, 54% of programs reported 2-4 weeks, and 12% of programs reported > 4 weeks of clinic. Fifty-one percent of program directors felt more than 4 weeks of clinical exposure to headache was needed to adequately prepare neurology residents. Ninety-six percent of program directors surveyed believed their residents were adequately prepared to diagnose and treat headache disorders. Twenty-one percent had plans to increase didactic time and 26% planned to incorporate more clinical exposure.

Conclusions: Despite a modest increase in headache didactics in neurology residency programs over the last decade, many program directors and chief residents report that their programs do not include what they believe to be adequate educational experiences in headache. Although the overwhelming majority of neurology residency programs reported that residents were adequately prepared to diagnose and treat headache disorders, about a fourth of programs still felt the need to increase the amount of didactic and clinical exposure dedicated toward the management of headache disorders.