So many migraines, so few subspecialists: analysis of the geographic location of United Council for Neurologic Subspecialties (UCNS) certified headache subspecialists compared to United States headache demographics.

Objective To evaluate the geographic location of the United Council for Neurologic Subspecialties (UCNS)-certified headache subspecialists as compared with ratios of expected migraine and chronic migraine populations in the United States. Background The UCNS is a professional medical organization that accredits fellowship programs and certifies physicians who demonstrate competence in various neurologic subspecialties, including headache medicine. There are a limited number of UCNS-certified headache subspecialists currently practicing in the United States. Methods All of the UCNS-certified headache subspecialists were geographically located and compared with demographic data about state populations obtained from the U.S. Census. The expected migraine and chronic migraine populations were calculated for each state based on recently published epidemiologic data. Ratios of UCNS-certified headache subspecialists to expected migraine and chronic migraine populations were compared for each state. These data were then organized by U.S. Census region and division. Results As of the 2012 examination cycle, 416 UCNS-certified headache subspecialists are currently practicing in the United States. The states with the highest number of headache subspecialists include New York, California, Ohio, Texas, Florida, and Pennsylvania. Six states have zero headache subspecialists, eight states have one headache subspecialist, and five states have two headache subspecialists. As per the U.S. Census, the total U.S. population for ages 12 years and older is 259,908,563. The total expected migraine population (11.79% of the general population) for ages 12 years and older is 30,594,362. The total expected chronic migraine population (0.91% of the general population) for ages 12 years and older is 2,361,397. The states with the best ratios of headache subspecialists to expected migraine and chronic migraine populations include the District of Columbia, New Hampshire, New York, and Nebraska. Besides states with zero headache subspecialists, the states with the worst ratios of headache subspecialists to expected migraine and chronic migraine populations include Oregon, Mississippi, Arkansas, and Kansas. When organized by U.S. Census regions, the Northeast has the best ratios of headache subspecialists to expected migraine and chronic migraine populations, while the West has the worst ratios of headache subspecialists to expected migraine and chronic migraine populations. In terms of U.S. Census divisions, the Middle Atlantic has the best ratios of headache subspecialists to expected migraine and chronic migraine populations, while the East South Central has the worst ratios of expected migraine and chronic migraine populations. Conclusions There is a disproportionately small number of UCNS-certified headache subspecialists compared with the extensive expected migraine and chronic migraine populations in the United States. More UCNS-accredited fellowship programs and more UCNS-certified headache subspecialists are needed in order to ameliorate this disparity.