Summary: It is often assumed that a neurologist or a pain specialist, by default, is a headache specialist. This article explains how headache specialists are far better equipped to diagnose the patient precisely according to the highest standard, following the International Headache Society’s criteria for headache and face pain diagnosis. A headache specialist, as you will find at Pacific Rim Headache Center, have the knowledge base and experience to help the sufferer find the optimal care. We are board certified in headache medicine by the United Council of Neurologic Subspecialties which should make it clear that we offer a level of care that is beyond what a general neurologist or a pain specialist can offer. At this time we are the only practice in the state of Washington that this prestigious certification outside of downtown Seattle and only the fifth board certified headache specialty practice in the entire Pacific Northwest.
It is a great misconception that neurologists = headache specialists. It is true that headache disorders in general are neurological illnesses. It is also true that most headache specialists are neurologists but most neurologists are not headache specialists. It takes special training and experience to be a headache specialist in the same way it takes special training to be a cardiologist and no reasonable internist would declare him or herself a cardiologist after just a few lectures about heart disease. We have a tremendous respect for neurologists who must know a lot about a wide spectrum of complex neurological diseases, however, if the neurologist has not had specialty training in headache, they may not have much more to offer than the general practitioner (see the supporting letter of this fact at the bottom of this article, which was written by Dr. Sylvia Lucas, a neurologist and director of the U. of Washington Headache Clinic).
While I’ve spent most of my 35-year career in neurology, specifically in headache medicine, neither Dr. Moren or myself are neurologists. We are associated with Cascade Neurologic Clinic, who are board certified neurologists, and do see patients within their clinic and see their headache patients within our other clinic sites.
Our training and experience in headache medicine is extensive and perpetual and far exceeds the training in headache medicine experienced by most neurologists. Like us, about 20% of headache specialists are not neurologists. The current president of the American Headache Society, Dr. Elizabeth Loder, is not a neurologist, yet, she is highly esteemed for her work in headache medicine and directs the prestigious John R. Graham Headache Center in Boston. The world’s first and largest headache center, The Diamond Headache Clinic in Chicago, was founded by a non-neurologist physician and is presently directed by an Emergency Medicine physician, Dr. Merle Diamond.
The historical problem in neurologists’ lack of training in headache medicine has to do with the fact that society as a whole has discriminated against headache disorders since the beginning of time. The reasons for this discrimination are two-fold. First, it is primarily a disorder of women which, unfortunately, has had gender discrimination and secondly . . . it is invisible. For centuries headaches have not been taken seriously. First they were attributed first to demonic activity and in the past century as an emotional problems. For that reason neurological training has neglected the study of headache as a legitimate medical disorder, as have medical schools in general. We hope that is changing. Headache disorders, like all areas of medicine, are quite complex and require extensive training to understand and become competent in treating them.
Studies have shown that over 22% of medical schools don’t have a single lecture on headache disorders. Of those that did have lectures on headache, the amount of time varied between one and four hours per year which is vastly inadequate for competency. In another study, looking at both medical school and neurological residencies and headache education, found that the typical medical school had a mean of about 3 hours of headache lectures during their four years. Over 88% of these medical schools said that this was adequate and over 92% said that they have no plans to increase the number of lectures. Eleven percent of the neurology residency programs reported less than three hours of lectures on headache during the four year program while 22.73% had 3-5 hours of lectures and 63.64% had at least 5 hours.
Another survey looked at neurology residency training and found that 20% percent of the neurology programs reported that they didn’t have a single lecture or discussion about headache during their four-year program.
I am a PA and during my school training we also received only about two hours of headache education. However, my expertise is based on the years of training I had after PA school. During my first four years out of school I was privileged to work side by side with Dr. Joel Saper. We created the world’s first inpatient headache treatment center. Dr. Saper was a tremendous mentor and recently became the first headache specialist in the world to win the Life-time Achievement award in headache medicine.
I later joined Mayo Clinic’s prestigious Headache Division of Neurology, which has been ranked by US News and World Report for years as the number one in quality. At Mayo, I had over four years of additional and invaluable training. While serving as a headache consultant there, I saw the most complex headache patients from around the world and worked independently.
Dr. James Moren has been a practicing family practice physician in Whatcom County for over thirty years. He became interested in and passionate about headache disorders more than a decade ago. He first went for personalized training with a headache specialist. He then became a member of the American Headache Society and has been involved in headache training with them since. He passed the difficult Headache Subspecialty Board Exams in October, 2014 and is board certified in headache medicine.
I estimate that I have been exposed to over 5,000 hours of dedicated headache lectures and case presentations and have cared for over 30,000 unique headache sufferers in my career. To stay on the cutting edge of headache medicine, Dr. Moren and I attend at least 30 hours of additional training with either the American or International Headache Societies each year and read the major headache research journals monthly.
Trained as primary care providers Dr. Moren and I believe that we bring something unique to the table beyond our expertise in complex headaches disorders and that is a listening skill, compassion and a comfortableness with treating all ages.
To help differentiate between general neurologists and headache specialists the United Council for Neurologic Subspecialties (UCNS) has created a board certification process for headache specialists. Since UCNS is a neurological group, they opened this process only to neurologists who have finished a one-year headache fellowship and passed a national exam. The trouble is, so few neurologists have qualified for or even shown interest in the board certification for Headache Medicine, that the need could never be met by these designated headache specialists. For example, the entire state of Washington has only four headache specialists. Many states don’t have a single UCNS Board Certified headache specialist.
I recently passed the first headache Medicine Board exam offered by the National Headache Foundation and am now a holder of Certification in Additional Qualification (CAQ) in Headache Medicine.
In conclusion, headache problems usually stem from a complex medical disorder that requires years of dedicated training, expertise and compassion to help patients navigate through and to get well. The sufferer deserves to be seen by a headache specialist and not just the local neurologist that is part of their primary care provider’s system.
J. Michael Jones, MPAS-C
 Finkel AG. Academic Headache Medicine in America: Report of Academic Membership Survey of the American Headache Society Special Interest Section on Academic Affairs. Headache 2003;43:266-271
 Gallagher RM, Rolande A, Shiwan S, Mueller L, Rogers J. Headache in Medical Education: Medical Schools, Neurology and Family Practice Residencies. Headache 2005;45:866-873.
 Young W, Rosen N, Sheftell F. Square One: Headache Education for the Medical Student. Headache 2007;47:351-354.
 Dr. Sylvia Lucas: Letter