General Advice about Headache Fellowship

[Nonphysiologic]

Hey everyone,

I am a current PGY-3 and I've decided I want to apply for Headache Fellowship. I looked through the UCNS website, seems like there aren't that many fellowships. Is this a competitive fellowship? The other problem is I dont have any research experience at all. Will this hurt me?

Thanks.

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[danielmd06]

Hey everyone,

I am a current PGY-3 and I've decided I want to apply for Headache Fellowship. I looked through the UCNS website, seems like there aren't that many fellowships. Is this a competitive fellowship? The other problem is I dont have any research experience at all. Will this hurt me?

Thanks.

This is not a competitive fellowship. I cannot imagine a lack of research hurting you. My advice? If you really are interested, why not see if you could do some case reports just for your own growth and to polish up your CV some? Maybe it would make your application shine for a more glamorous place for fellowship.

 

[typhoonegator]

People tend to use research as a proxy for interest. Show that you're invested in headache however you can. As daniel said, not particularly competitive, although if you get yourself set up right after fellowship, you can have a good lifestyle and an excellent salary given the proliferation of boutique headache centers out there. You gotta be good at mastering countertransference though.

 

[neurologist]

You gotta be good at mastering countertransference though.

 

[bustbones26]

Okay, first off, Headache medicine may not be as competitive as other subspecialites, but there are some competitive programs out there within the field.

Jefferson has more than enough applicants to choose from

Most of the programs within NYC interview and apply very early. I believe it was St. Lukes/Roosevelt that decides by March who their chosen fellow is?

Mayo has two programs, one in Rochester and one in Scottsdale. Its Mayo, they fill and their internal application is fairly competitive. Some program that I applied to pretty much wanted LOR and to see your CV. Mayo asked for my genetic karyotype (that was a joke, not being serious, but they did probe hard).

All of the NYC programs fill fast and early!!! (see my comment above). Lipton is at Albert Einstein and is considered one of those giants that walks on water, thus, they all fill fast.

At the end of the day, headache medicine is like every other specialty, the top/competitive programs fill fast and early and yes, would require a solid CV and perhaps some research. The other programs, well, it will not hurt you.

But you're a PGY-3? Nothing fancy needs to be done here to show your interest. Case report? A simple idea that will publish a poster at the next scientific meeting (if you see the crap they accept, you'd realize this is not hard to do).

But indeed, it probably is a little to late in your residency to obtain IRB approval for a big study.

 

[Nonphysiologic]

Thanks for the advice.

Any input on the Stanford program? Or the USC?



How much of a headache fellowship is procedure based?

 

[Nonphysiologic]

Okay, first off, Headache medicine may not be as competitive as other subspecialites, but there are some competitive programs out there within the field.

Jefferson has more than enough applicants to choose from

Most of the programs within NYC interview and apply very early. I believe it was St. Lukes/Roosevelt that decides by March who their chosen fellow is?

Mayo has two programs, one in Rochester and one in Scottsdale. Its Mayo, they fill and their internal application is fairly competitive. Some program that I applied to pretty much wanted LOR and to see your CV. Mayo asked for my genetic karyotype (that was a joke, not being serious, but they did probe hard).

All of the NYC programs fill fast and early!!! (see my comment above). Lipton is at Albert Einstein and is considered one of those giants that walks on water, thus, they all fill fast.

At the end of the day, headache medicine is like every other specialty, the top/competitive programs fill fast and early and yes, would require a solid CV and perhaps some research. The other programs, well, it will not hurt you.

But you're a PGY-3? Nothing fancy needs to be done here to show your interest. Case report? A simple idea that will publish a poster at the next scientific meeting (if you see the crap they accept, you'd realize this is not hard to do).

But indeed, it probably is a little to late in your residency to obtain IRB approval for a big study.

Also, when you say programs start accepting early, do you mean March of PGY-3 Year? So basically that means I have to get my CV, LOR, any potential case reports ready right now being that I just started my PGY-3. Right?

 

[Nonphysiologic]

Okay, first off, Headache medicine may not be as competitive as other subspecialites, but there are some competitive programs out there within the field.

Jefferson has more than enough applicants to choose from

Most of the programs within NYC interview and apply very early. I believe it was St. Lukes/Roosevelt that decides by March who their chosen fellow is?

Mayo has two programs, one in Rochester and one in Scottsdale. Its Mayo, they fill and their internal application is fairly competitive. Some program that I applied to pretty much wanted LOR and to see your CV. Mayo asked for my genetic karyotype (that was a joke, not being serious, but they did probe hard).

All of the NYC programs fill fast and early!!! (see my comment above). Lipton is at Albert Einstein and is considered one of those giants that walks on water, thus, they all fill fast.

At the end of the day, headache medicine is like every other specialty, the top/competitive programs fill fast and early and yes, would require a solid CV and perhaps some research. The other programs, well, it will not hurt you.

But you're a PGY-3? Nothing fancy needs to be done here to show your interest. Case report? A simple idea that will publish a poster at the next scientific meeting (if you see the crap they accept, you'd realize this is not hard to do).

But indeed, it probably is a little to late in your residency to obtain IRB approval for a big study.

Hey I thought of another question. This one is especially for Bustbones26.

A lot of the staff neurologists at my institution that run the botox clinic or are "headache specialists" are not UCNS certified and have various subspecialites from Stroke to the most common being neurophysiology. One didn't even do fellowship but she shadowed a headache doctor for 3 months and went to some courses or something like that.

So my basic question is this. Is a headache fellowship even really necessary? What would a headache fellowship offer me that a neurophysiology or just focusing on headaches during my general residency wouldnt? Also, just how much exactly is headache fellowship procedure driven?

Ideally Id like to be involved in a procedural based neuro field only because I think its a good asset to have to be skilled in procedures to complement a general neurology practice.

 

[Nonphysiologic]

Bump!

 

[neurologist]

Hey I thought of another question. This one is especially for Bustbones26.

A lot of the staff neurologists at my institution that run the botox clinic or are "headache specialists" are not UCNS certified and have various subspecialites from Stroke to the most common being neurophysiology. One didn't even do fellowship but she shadowed a headache doctor for 3 months and went to some courses or something like that.

So my basic question is this. Is a headache fellowship even really necessary? What would a headache fellowship offer me that a neurophysiology or just focusing on headaches during my general residency wouldnt? Also, just how much exactly is headache fellowship procedure driven?

Ideally Id like to be involved in a procedural based neuro field only because I think its a good asset to have to be skilled in procedures to complement a general neurology practice.

So, my 2 cents:

Given that 1/3 to 1/2 of general neurology practice is dealing with headaches, I'm not sure that doing 100% headache work during a one-year fellowship really adds much in the way of hands-on clinical experience that you wouldn't get from "just bein' a neurologist" and keeping up with the literature. The only major advantage of a headache fellowship, IMO, is the ability to pick the minds of the headache gurus in person on a daily basis for a year. There may also be some secondary gain if you want to be an academic and need to do research/network as well, but that's about it. If those seem like worthwhile advantages, well, I guess go for it. Or, if you just happen to like headache stuff, sure, do a fellowship -- you'll probably love it.

Headache is not particularly procedure based. Mostly superficial injection stuff like botox, trigger point injections, etc. While things like occipital nerve stimulators and sphenopalatine blocks do get done, it's not the neurologist that's doing them.

And BTW, a neurophysiology fellowship won't offer any headache training at all -- which is probably one reason why it's such a popular fellowship . . .

 

[chickensoupdr]

I am interested in a headache fellowship but in a residency program with no headache specialist.
Anyone out there can provide the basic details - what a normal clinic day looks like, patient population, salary, how high in demand headache specialty is, what procedures to expect, etc.
I have searched online and found some answers but I would love to hear it from someone who actually has personal experience in this field.

 

[xenotype]

Hey I thought of another question. This one is especially for Bustbones26.

A lot of the staff neurologists at my institution that run the botox clinic or are "headache specialists" are not UCNS certified and have various subspecialites from Stroke to the most common being neurophysiology. One didn't even do fellowship but she shadowed a headache doctor for 3 months and went to some courses or something like that.

So my basic question is this. Is a headache fellowship even really necessary? What would a headache fellowship offer me that a neurophysiology or just focusing on headaches during my general residency wouldnt? Also, just how much exactly is headache fellowship procedure driven?

Ideally Id like to be involved in a procedural based neuro field only because I think its a good asset to have to be skilled in procedures to complement a general neurology practice.

Headache is a huge part of general neurology in the community, and botox for migraine/ONB/TP is easy to learn and quite standardized if you follow the FDA approved protocol (potentially better results for individual patients if you don't do the standard injections). Headache specialists at my institution worry more about complications (brow weakness, head drop) than individual injections being ineffective because of the chosen injection sites. Everyone at my residency program does mandatory headache rotations and easily get >50 botox injections directly. Most private practice neurologists in my region are doing botox or even have midlevels doing it.

If you want procedural skills, headache is a poor choice. EMG with some botox exposure in a NM or CNP fellowship (potentially movement as well) is a far better choice as these are much more complex. Interventional pain is the most procedural choice but is quite competitive. The main reason to do a headache fellowship would be because you like headache and headache patients, and it helps greatly with an academic career. Some neurology residencies are desperate for boarded headache faculty and I've seen some high offers for friends (higher than other neuro specialties in academics). In day to day practice it would add little other than you'd have a much bigger toolbox and experience for dealing with tougher headache patients that don't respond to the usual protocols.