NeuroVoices: Sara Pavitt, MD, on the Need to Educate the Clinical Community on Pediatric Headache

Sara Pavitt, MD

Among children between 5 and 17 years of age, around 20% have reported getting headaches, the most common being tension headaches and migraines. Children with high stress levels and those with immediate family members with headaches are more prone to developing headaches. There are several possible causes, including simple illnesses, anxiety, depression, meningitis, head trauma, tension, and ear infections, among others. Although rare, children with encephalitis, hemorrhage, or tumors may also develop headaches.

The prevalence of headache increased with age, and remains the most common neurologic complaint in the pediatric population. There are estimated to be fewer than 60 fellowship trained pediatric headache specialists with only 9 pediatric headache fellowships in the United States. To address gaps in the overall knowledge and care for pediatric headache, Sara Pavitt, MD, and Irene Patyinot, MD, created the International Pediatric Headache Didactic Series, a novel educational intervention.

Pavitt, chief of headache at UT Austin Dell Children’s Hospital, presented data from the first year of the series at the 2023 American Headache Society (AHS) Annual Meeting, held June 16 to 18, in Austin, Texas. A total of 396 participants signed up for the lectures, 56% (n = 211) of which felt competent or very competent in headache knowledge prior to starting the series. Advanced practice providers (n = 118) and MD/DO headache faculty (n = 115) accounted for the largest clinical roles who attended the series, followed by several other positions, including adult (n = 59) and pediatric (n = 48) headache fellows.

As part of a new iteration of NeuroVoices, Pavitt sat down to discuss the reasons behind the series, including the need to educate the broad clinical community on pediatric headache. She provided perspective on the basics facts clinicians should know, and how the course continues to evolve with headache research and news.

NeurologyLive®: How did this didactic series come about?

Sara Pavitt, MD: The series itself is biweekly, held every other Friday, that runs through the academic year, from July to July. It's a set curriculum that repeats every year. The goal of it is to provide dedicated pediatric headache education to a broad and wide audience. It's delivered virtually to allow increased accessibility, not only for lecturers to present, but also for attendees. My co-creator Irene Patyinot, MD, and myself are both headache fellowship directors. In pediatric headache, the faculty who tend to be on site are relatively small, there might be 1 or 2 of us. As we were discussing what we were going to do to train our fellows, it became very obvious that we wanted to have increased access to different learning styles and types for our headache fellows.

They weren't just learning from me or Dr. Patniyot, MD. As we started to discuss this together, we thought, why don't the 2 of us just teach our fellows. As we started talking to the broader pediatric community, it became very evident that this was a need for all pediatric headache fellowships. Not only that, but we also had a lot of other types of providers, nurse practitioners, physician assistants, nurses, who were interested in getting this type of training. We opted to open it to everyone. Let's have a broad range of lectures, get people from all over the world to deliver these lectures, and allow anyone from any background to view whatever lecture they want to do.

What should be universally known about headache among clinicians, regardless of their subspecialty?

Headache is the most common neurologic symptom that presents to the physician's office. Every type of physician, no matter if you're in neurology or outside of neurology, is going to see these patients. Migraine tends to come with a lot of other comorbid conditions. If you might be seeing a gastroenterologist for irritable bowel syndrome, that patient might also have migraine. When we think about training and educating, it's really trying to educate the masses as much as we can. When I think about educating different groups of people, I do feel like there are essential components that everyone should learn about. Those include identification and diagnosing migraine, and feeling comfortable in the diagnosis given how common it is.

Following that, [clinicians should] understand how to approach acute treatment, and what to do during a migraine attack. How do we think about starting preventive treatment? How do we enact that? What are our options? What can we do? The other aspect that's important is having a sense and learning about migraine epidemiology, understanding how common it is, and how disabling it can be. We know it's the second most disabling disease worldwide, so understanding how that can impact your patients. As physicians, can we identify that and help them move forward and improve their ability to function?

Do you have to tailor conversations about headache to specific subspecialties?

When I think about creating the curriculum for the didactic series—which had a lot of discussions [prior to its initiation]—we based it on the UCNS (United Council for Neurologic Subspecialties), which is one of our headache boarding bodies. They have specific recommendations that every single pediatric headache fellow should know through their fellowship. We took those specific recommendations, and with our pediatric colleagues, asked about other types of topics we are seeing in clinic and in practice. We put those in to create this 23-lecture curriculum.

Every year, we have those core topics that will repeat, but then we switch out others with new, interesting, and exciting topics to keep our audience engaged. Being able to tailor this virtual lecture series gives people the ability to think about what is going to be most beneficial for their practice. They can make sure to log in for those lectures, whereas there may be another lecture that might be more targeted towards fellows that a nurse practitioner might say, "I don't necessarily need to be in that one."

Over time, how do you assess what needs to changed with the course?

We try to get a lot of input from our attendees. We just sent out a post survey this last week asking the 400 people who signed up for this lecture series: what did you like about it? What could we change? What other topics would be helpful for you to learn about? I would say this is probably the biggest way that understand and get information for the topics. We also think about new and emerging things that might be happening in our field, including research being presented at this meeting. For instance, this year, we added a lecture on vertigo and migraine because we didn't have one before. That's a topic that [clinicians] came out really loud, and we wanted to be able to have this discussion and have a lecture for it. A lot of it's coming from: what's going on with the field, in general, but also, what do the attendees want, moving forward?

Transcript edited for clarity. Click here for more coverage of AHS 2023.