Two Questions: Are We Neurologists? What do We Offer? Part I

These two questions are the ones most commonly asked by inquirers who call. I wanted to give a brief answer to those here.

I will deal with this first question and come back and address the second.

No, neither Dr. Moren or myself are neurologists. This was not by design, meaning we have no issues with neurologists caring for headache patients. Indeed, I believe now more than ever that headache is a neurological disease.  Historically, however, headache disorders has not been taken very seriously within the field of neurology until recently.  There is a false assumption that being trained as a neurologist prepares you as an expert in headache.  Nothing could be further from the truth, especially for neurologists trained more than ten years ago.  In an article in the Headache Journal, one neurologist did a survey and found about 40% of the neurologists never received a single lecture on headache disorders during their four year residency. Only a very small percentage spent even a week in a headache clinic as part of their training.

I personally have a great respect for neurologists and the diverse and complex disease states they must know about and manage.  Things are changing and now there is a track for a neurologist to get a one year fellowship in headache and take a sub-specialty board exam. That track may be great in ten years. Presently, there are only about three neurologists in the country who finish such a program each year.

Headache disorders are the most common cause for suffering in the world.  It is also, by far, the most under treated.  If we relied only on the neurology track to produce qualified headache experts, then 99% of the sufferers would remain without treatment.

I am a Physician Associate (PA). This required me to have a BS degree in science then work two years in a hospital internship, then two more years of an intensive medical school. In addition to that, I finished a masters in PA studies with an emphasis in neurology.  However, my program, while giving me a good grip on the basics of medicine, did not make me a headache specialist.

What made me a headache specialist was having 4 1/2 years of one on one training with Joel Saper, MD, who is a neurologist and one of the top headache specialist in the world. Then I had an additional six years of training in headache at Mayo Clinic’s Headache Division.  The US News and World Report declared our department (neurology) the highest quality one in the nation.  On top of those years I have spent one week per year in intensive training programs through the American Headache Society for almost 20 years.  You must be part of this annual training to keep up to date in headache research and current thinking.

Dr. Moren is an outstanding physician and was trained and certified in family practice.  It was his personal passion for helping headache sufferers that led him to seek additional training in headache. He did train with some local neurologists and has attended the American Headache Society annual training meetings for the past decade.  He and I both read the Headache research journals every month and that is another vital resource for helping us stay on top of the field.

I must also point out that the very first headache clinic and still the world’s largest, was started by a family practice physician, Seymour Diamond. It is now directed by his daughter, a physician certified in Emergency Medicine.  So, while it is true that most headache specialist were neurologists first, most neurologists are not headache specialists.

In closing I will also add that a good headache specialist involves two parts, knowledge and caring. Dr. Moren and I both care deeply about our patients. We did not develop a headache clinic as a business venture but as a desire to bring the best headache care to the greatest number of people.

J. Michael Jones, MPAS-C