American Headache Society President Paul Winner
On Improving Research, Training, and Reimbursement
In his own words, inspiration comes easy for the president of the American Headache Society (AHS). Paul Winner, DO, who began his two-year AHS presidency in June 2006, characterizes the society as vibrant, dedicated, and extremely supportive of members and young researchers.
In addition to his AHS post, Dr. Winner is a clinical professor of neurology at Nova Southeastern University in Fort Lauderdale, FL, and the director of the Palm Beach Headache Center at Palm Beach Neurology. He is also the director of the Premier Research Institute at Palm Beach Neurology.
Dr. Winner trained in neurology and pediatrics at Albert Einstein College of Medicine in New York. Neurology “giants” Isabelle Rapin, MD, and Seymour Solomon, MD, were among those who piqued his interest in headache disorders.
Dr. Winner spoke to Neurology Today about the growing organization he leads.
TELL US ABOUT YOUR INVOLVEMENT IN THE ORGANIZATION PRIOR TO BECOMING PRESIDENT
I have been involved in the AHS since my neurology residency at Montefiore Medical Center at the Albert Einstein College of Medicine in the late 1980s. Dr. Seymour Solomon, who was the director of the Headache Center there, was instrumental in getting the residents to appreciate the importance of headache disorders and the importance of getting solid educational and research exposure to this field. He encouraged us to attend the postgraduate educational programs and the annual scientific meeting of the AHS. While Dr. Solomon was the president of the society, he asked me to become a course director for the society. I have also been a member of the AHS board for more than ten years.
HOW IS THE AHS INVOLVED IN EDUCATION ABOUT HEADACHE DISORDERS?
The top issue for the AHS is education about headache disorders, both primary and secondary, for medical students, residents, and postgraduates. And that is happening at multiple levels. For example, there is now a special UCNS [United Council for Neurological Subspecialties] certification examination for Headache Medicine sponsored by the AHS, which began in late 2006. We worked along with the AAN to establish the core curriculum, which includes 200 questions from five primary topics: epidemiology and comorbidity, anatomy and physiology, headache classification and diagnosis, evaluation and diagnostic testing, and treatment.
The next Headache Medicine certification exam is scheduled for October 8–12, 2007. (A complete description can be found in the Headache Medicine Core Curriculum at: www.ucns.org/certification/requirements/#headache.)
We also offer AHS fellowships and promote other funding sources for research on headache disorders. We offer CME and other educational resources through our Web site: www.AmericanHeadacheSociety.org. A special section of the Web site, ACHE, is devoted to patient education, www.ACHEnet.org.
REIMBURSEMENT IS A COMMON CHALLENGE AMONG NEUROLOGY AND OTHER COGNITIVE SPECIALTIES. WHAT ARE THE ISSUES FOR HEADACHE SPECIALISTS?
We want to improve the present ICD-9 coding system for headache diagnosis and reimbursement. The current ICD-9 codes do not include many of the primary headache disorders that are classified in the International Classification of Headache Disorders 2nd edition; as a result, physicians must use a code that is close to the accurate diagnosis. With the ability to code for chronic migraine in the future, we should be able to improve insurance coverage for the more disabled headache patients who are often seen in secondary and tertiary neurology practice (headache specialty practices and university headache centers).
DOES THE AHS GET INVOLVED IN FEDERAL, STATE, OR LOCAL ADVOCACY EFFORTS?
The AHS has been an instrumental part of a consortium of headache and pain organizations called the Pain Care Coalition that have been working with Congress to elicit more resources for headache and pain disorders for several years. The other organizations include the Headache Cooperative of New England, National Headache Foundation, World Health Organization, MAGNUM/National Migraine Association, European Brain Council, European Headache Federation, Migraine Trust, and British Association for the Study of Headache. Former AHS President Dr. Joel Saper continues to lead this effort. The AHS has been training doctors how to address Congress through special advocacy days like “Headache on the Hill,” urging stronger support from the NIH for headache and migraine research. The first one was scheduled for September 25–26 in Washington, DC.
WHAT ARE THE MOST DIFFICULT CHALLENGES FOR YOUR MEMBERS?
Our members face similar challenges as other physicians and allied health care professionals. Everyone would like more support for research. We would like to have more time for patient evaluations. We would like to develop more headache educational programs, to develop more headache fellowship training, and to increase inpatient hospital units throughout the US. It is becoming increasingly difficult to manage intractable headache patients on an outpatient basis. If we are able to hospitalize an intractable headache patient, the two or three days allowed by the insurance companies are often not enough. An inpatient hospital unit with fully trained personnel can usually improve the quality of the patient's life in one to two weeks; often it could take months to achieve similar results in the outpatient setting
Another challenge is to increase support for the educational venues that are part of these inpatient units, such as improving patient education in hospitals. We would like to see more courses on headache and headache-related disorders in the universities, as well. This would impact the growth of our subspecialty and influence the advancement of the science of headache.
WHAT DO YOU SEE AS SOME OF THE AHS's BIGGEST ACCOMPLISHMENTS?
AHS members Drs. David Dodick and David Capobianco helped develop a neurology residency training headache program that is being adopted in neurology residency training programs throughout the United States. Similar efforts are under way to help train medical students to diagnose and manage primary and secondary headache disorders.
One of my major accomplishments at this point is improving Web access and educational programs for our members, and at the same time helping to obtain name recognition for the American Headache Society so that clinicians and the public will be better able to take advantage of the many programs and education we offer.
HOW DOES THE AHS WORK WITH THE AAN?
The AHS works extremely well and often in tandem with the AAN to promote research, improve patient care and education, and address legislative concerns. Many of the AHS members are also members of the AAN Headache Section. More than 60 percent of our members are neurologists. This relationship helps both organizations remain strong and vibrant.
THE SCOTTSDALE HEADACHE PROGRAM IS COMING UP IN EARLY NOVEMBER. CAN YOU GIVE US A PREVIEW OF HIGHLIGHTS FOR THE CONFERENCE: WHAT WILL BE NEW THIS YEAR?
Our next postgraduate education program is scheduled for Scottsdale, AZ, on November 1–3. We have a superb lineup of expert speakers, both national and international, who will be presenting their own research with a strong focus on clinical medicine.
Highlights include sessions on the genetics of migraine and recent discoveries and special satellite symposiums in emergency room and inpatient management of headaches; headaches in children and adolescents; and establishing a headache practice. There will be special topics on neuro-ophthalmology, orofacial issues, cluster headache patterns, and psychiatric disorders as they relate to headache. Our Web site has the entire program online.
Our annual meeting is scheduled for June 26–29, 2008, in Boston, and as it's our 50th anniversary, it will be a very special occasion.
For more on the American Headache Society, visit www.americanheadachesociety.org.