GUEST EDITOR IN CHIEF
Nina Riggins, MD, PhD, FAAN, FAHS, is a board certified Neurologist and UCNS certified Headache Specialist. Riggins completed her Internal Medicine internship at Texas Tech University, and her neurology residency at Penn State Medical Center. Riggins completed her clinical neurophysiology fellowship at the State University of New York, Buffalo and headache medicine fellowship at the University California, San Francisco. Before joining TNC, Riggins directed a headache Center at UC San Diego.
Her work revolves around progressive research and effective treatment for people battling pain and suffering including but not limited to Migraine, Cluster Headache, Hemicrania, Post-traumatic Headaches. Riggins is a Vice Chair of the American Academy of Neurology Headache & Facial pain section and First Contact Program of American Headache Society.
“I believe that this current progress in research, education, and management of neurological diseases would not be possible without advocacy.”
I am honored to be invited to guest-edit this edition of NeurologyLive.
I would like to take this opportunity to celebrate recent achievements in the field of neurology. I believe that this current progress in research, education, and management of neurological diseases would not be possible without advocacy. In addition to my clinical work, I serve the community as vice chair of the BrainPAC Executive Committee of the American Academy of Neurology (AAN) and a Miles for Migraine board member. I graduated from the AAN Palatucci Advocacy Leadership Forum (PALF). My PALF project was “Anticipatory Pediatric to Adult Transition Program for Patients With Headaches.” My patients inspired this work. There is a common gap in care during the transition from pediatricians to adult neurologists.
About 1 in 11 children have migraine. Many kids will have to find adult primary care and an adult neurologist when they reach age 18 years. Current workflow can make it difficult for patients to navigate the medical system at that time. Our kids deserve timely access to quality care.1
The objectives for this project were:
- Optimizing workflow for the transition from pediatricians to adult neurology for headache care
- Listing items for timely discussion during clinic visits to prevent gaps in care transition
- Improving brain health by providing timely medical care during the transition from pediatricians to adult neurology
The actions we took were:
- Interviewing pediatricians and adult headache specialists
- Creating recommendations for transition of care in the form of a checklist
I appreciate the participation of AAN and American Headache Society members. I want to express special gratitude to all members of AAN PALF, including my project adviser, Amaal Starling, MD.
Our proposed measurements of success for use of the packet are as follows:
- Age of transition is the one identified by pediatricians
- How frequently adult neurologists have complete information from referring pediatricians on patients before and after this change in workflow
This checklist is for pediatricians, neurologists, and any clinicians who treat teenagers. We recommend that clinicians address readiness for transitioning from pediatric to adult neurology care once a year, starting at age 15 years.
The checklist is one of the most used, structured health care transition interventions and we hope it will help our patients living with migraine and their families.2,3
Packet – Checklist PALF AAN
Proposed checklist for annual patient visits with pediatricians, starting at age 15 years:
Anticipated age to transfer care
___________________________________________________________
Headache medicine diagnosis
____________________________________________________________
a) Age of diagnosis
________________________________________________________________
b) Frequency (number of days with headaches in the past 30 days)
____________________________
c) Current and prior treatments
______________________________________________________
Evaluations of headache (MRI brain, eye exam, etc)
___________________________________________
Past medical and surgical history
__________________________________________________________
Family medical history
__________________________________________________________________
Social history
_________________________________________________________________________
Barriers to transitioning care
_____________________________________________________________
Identify whether guardianship or health care proxy documentation is needed. Instruct guardian/conservator to provide a copy to a new adult provider.
_____________________________________________________
Nina Riggins, MD, PhD, FAAN, FAHS, UCNS Diplomate
FEATURES IN THIS ISSUE
ALZHEIMER DISEASE
Challenges and Opportunities Bringing Lecanemab to Neurology Community Clinics
By Jose Soria, MD; Olena Bueno, RN; Uriel Romero, MD; Claudia Asencio, MA; Kevin McGehrin, MD; Branko Huisa, MD
SLEEP DISORDERS
A provider's Cheat SheetGuide to Understanding Sleep
By Joanna Fong-Isariyawongse, MD, FAAN, FAES
HEADACHE AND MIGRAINE
College Checklist for People Living With Migraine
By Aishwarya Taneja, MD, FAAP
REFERENCES
1. Waung MW. Equipping for patient transfers in pediatric to adult headache care transitions. Headache. 2020;60(10):2129-2130. doi:10.1111/head.13982
2. Orr SL, Gelfand AA, Hranilovich J, et al. The development of the medical transfer packet for transition of care of the pediatric patient with headache. Headache. 2020;60(10):2589-2591. doi:10.1111/head.13948
3. Schmidt A, Ilango SM, McManus MA, Rogers KK, White PH. Outcomes of pediatric to adult health care transition interventions: an updated systematic review. J Pediatr Nurs. 2020;51:92-107. doi:10.1016/j.pedn.2020.01.002
