The International Pediatric Headache Didactic Series: A Novel Curriculum Innovation

Abstract

Objectives

The International Pediatric Headache Didactic Series (IPHDS) was developed to provide free, comprehensive pediatric headache education to healthcare professionals worldwide. The objective of this study was to describe the design, implementation, and impact of this prospective educational intervention.

Background

Headache is the most common neurological symptom within the pediatric population. Yet, only nine fellowships are offered in pediatric headache medicine. Limitations in access to education and training are often cited as reasons for diagnostic and management barriers. To address this gap, the IPHDS was established in July 2022.

Methods

IPHDS is a recurring series consisting of 23 biweekly lectures. Lectures are delivered virtually via Zoom and available for asynchronous learning on an open‐access website. Lecture topics are based on the United Council for Neurologic Subspecialties' curriculum recommendations. Pre‐ and post‐surveys were developed collaboratively by content experts and administered to attendees. Quantitative data were analyzed using descriptive and inferential statistics, and qualitative data were analyzed using conventional qualitative content analysis.

Results

From July 2022 to July 2023, over 480 people signed up for IPHDS. Lecture attendees represented a variety of clinical backgrounds including advanced practice providers (26.4%, n = 128/484), MD/DO headache providers (25.4%, n = 123/484), adult headache fellows (12.6%, n = 61/484), pediatric headache fellows (10.3%, n = 50/484), residents (8.1%, n = 39/484), clinical nurses (8.1%, n = 39/484), MD/DO neurology (non‐headache) providers (2.1%, n = 10/484), researchers (1.6%, n = 8/484), medical students (1.4%, n = 7/484), orofacial pain providers (1.0%, n = 5/484), psychologists (<1%, n = 3/484), and pharmacists (<1%, n = 3/484). Lecture attendees represented nine countries and 31 US states. Median attendance for live lectures was 34.0 people [interquartile range: 28.3–42.5], and median viewership of the posted lectures to date was 79.0 views [interquartile range: 52.0–93.0]. Prior to attending IPHDS, only 56.7% (n = 230/406) of participants reported being competent or very competent in headache medicine knowledge. After attending IPHDS, 76.9% (n = 40/52) of participants reported being competent or very competent in knowledge of headache medicine, as indicated in their post‐survey. Similarly, 78.8% (n = 41/52) of participants indicated that this didactic series moderately or significantly added to their knowledge of pediatric headache medicine.

Conclusion

This novel didactic series successfully delivered free pediatric headache education to healthcare professionals worldwide. Furthermore, this didactic series serves as a framework for other subspecialties looking to disseminate education from specialists in the field. IPHDS continues on an annual basis, following the academic calendar year, and now holds continuing medical education accreditation.

Plain Language Summary

Headache is the most common neurological symptom within the pediatric population, but there is a general lack of headache education in the medical training pipeline. In order to address this gap, the International Pediatric Headache Didactic Series (IPHDS) was created in July of 2022, for which 23 biweekly didactic lectures were offered in real time on Zoom and asynchronously through replays; 480 people signed up for the series over the course of the year. This novel didactic series successfully delivered free pediatric headache education to healthcare professionals around the world as evidenced by participants from nine countries attending and nearly 80% of survey responders (n = 41/52) reporting moderate to significant improvement in their knowledge of pediatric headache medicine.

Abbreviations

AHS

American Headache Society

ASD‐2030

2030 Agenda for Sustainable Development

CME

continuing medical education

IPHDS

International Pediatric Headache Didactic Series

BACKGROUND

Headache is the most common neurological symptom within the pediatric population and the second most common illness‐causing disability worldwide among individuals aged 15–49 years. ¹ , ² The prevalence of headache in the pediatric population is over 62%. ³ , ⁴ Headache in children can affect quality of life at levels equivalent to or greater than other chronic illnesses. ¹ , ⁵ In particular, children with headaches may have impaired functioning and performance at school. ³ , ⁴ , ⁵

The misdiagnosis of headache disorders can lead to significant societal burden. ⁶ Insufficient management can result in increased disability, chronification of episodic headache disorders, and decreased quality of life for pediatric patients. ⁶ The lack of education and training is often a reason for diagnostic and management barriers. ⁷ Effective pediatric care requires adequate headache education for healthcare professionals at all levels. ⁸

There is a vast shortage of fellowship‐trained pediatric headache specialists in the United States, with only nine established pediatric headache fellowships nationwide. ⁹ This scarcity may largely be attributed to the lack of headache education in the medical training pipeline. ⁸ , ¹⁰ On average, medical schools dedicate only 3 h to headache education, and a survey of American Headache Society (AHS) members revealed that 22% of medical schools do not offer formal lectures on headache. ¹¹ , ¹² Residency program directors believe that incoming residents do not have adequate knowledge of headache diagnoses and treatment. ¹¹ Despite this, most residency programs do not include a mandatory headache clinic rotation. ¹³ As a result, pediatric residency graduates report that they would feel more confident in serving pediatric patients with headaches if they had received more education during training. ¹⁴

Additionally, delays in obtaining an evaluation from a pediatric headache specialist can lead to the chronification of headache pain; as such, it is essential that primary care providers have the knowledge to effectively diagnose headache disorders and provide optimal management for children. ⁶ , ⁷ , ⁸ , ¹⁵ Pediatric headache education, created by fellowship‐trained pediatric headache specialists, should be offered to all medical students, residents, and healthcare professionals who provide services to the pediatric population. ¹⁵

Healthcare professionals report that expense is the biggest barrier to continuing medical education (CME). ¹⁶ Thus, pediatric headache education should be free and widely accessible. It should include fundamental knowledge of epidemiology and pathophysiology, extensive information on the clinical presentation and differential diagnoses of various headache disorders, and detailed reviews of available treatments, as per the conceptual framework derived from the 2030 Agenda for Sustainable Development (ASD‐2030). ¹⁵

OBJECTIVES

The International Pediatric Headache Didactic Series (IPHDS) was developed to provide free, comprehensive pediatric headache education to healthcare professionals worldwide. IPHDS was specifically designed to provide pediatric headache fellows with a structured educational experience that involved consistent interaction with experts outside their home institution. Over time, this novel curricular innovation enabled all healthcare professionals, regardless of background, to access adequate education on the pathogenesis, diagnosis, and management of headache disorders in the pediatric population. Furthermore, this didactic series serves as a framework for other subspecialties seeking to disseminate education from specialists in the field to all healthcare professionals who serve the target population. The objective of this study was to describe the design, implementation, and impact of this prospective educational intervention.

METHODS

Research ethics information

The Institutional Review Board for the University of Texas (UT) at Austin Dell Medical School (Austin, TX) determined that this study was not human subjects research and therefore did require formal informed consent. Participation in the surveys was voluntary, and consent to participate was implied by the completion and submission of the surveys.

Study design

This study was a prospective educational intervention evaluating the design, implementation, and impact of the IPHDS, a novel didactic series developed to provide free, comprehensive pediatric headache education to healthcare professionals at various levels of training worldwide.

Intervention components

In partnership with UT Health Austin Pediatric Neurosciences at Dell Children's and Texas Children's Hospital Headache Clinic (Austin, TX), IPHDS was created in July of 2022. ¹⁷ IPHDS is a free, recurring series consisting of 23 biweekly lectures following the academic calendar year. Each lecture consists of a 45‐min lecture‐style didactic with 15 min of open discussion. Lectures are delivered virtually via Zoom for synchronous learning and available for asynchronous learning on an open‐access website. ¹⁸

Lecture topics are chosen based on the recommended subjects to be covered in the United Council for Neurologic Subspecialties‐accredited fellowship program in headache medicine. ¹⁹ Lecture topics include epidemiologic principles, pathophysiology, headache classification, differential diagnoses, diagnostic testing, therapeutic modalities, and career development (Table 1). Lecture topics are in line with the conceptual framework derived from the ASD‐2030. ¹⁵

TABLE 1.

Lecture topic and speakers for the 2022–2023 academic calendar year.

Date	Lecture topic	Speaker
07/22/22	Migraine pathophysiology, history of migraine, and introduction to the ICHD‐33 classification criteria	Liza Smirnoff, MD
08/05/22	Acute migraine management	Irene Patniyot, MD
08/19/22	ED and inpatient management of status migrainosus and refractory headache disorders	Sara Pavitt, MD
09/02/22	Migraine preventive therapies	Marissa Lagman‐Bartolome, MD, FRCPC, FAHS
09/16/22	TACs (trigeminal autonomic cephalalgias)	Sophie Calvert, FRACP
10/07/22	Secondary headache: PTH/PPTH	Karen Barlow, MRCP, PhD
10/21/22	Secondary headache disorders: IIH and SIH	Klaus Werner, MD, PhD, MRCP, MRCPCH
11/04/22	Secondary headache disorders: vascular and tumor	Jonathan Paul Donnelly, MRCP
11/18/22	Refractory pediatric headache	Mariana Ciobanu, MD
12/02/22	Unusual headache syndromes/short‐duration headache	Prab Prabhakar, MD
12/16/22	Childhood periodic syndromes associated with migraine	Wilson Heredia, MD
01/06/23	Hot topics in headache medicine	Chris Oakley, MD
01/20/23	CBT and other behavioral therapy	Michelle Clementi, PhD
02/03/23	CBT and other behavioral therapy	Cathleen Turnage, PsyD
02/17/23	Physical therapy role in migraine	Ali Ladak, PT, DPT, PhD
03/03/23	Migraine epidemiology	Manuel Vides, MD
03/17/23	History of migraine and migraine stigma	Zuhal Ergonul, MD, PhD
04/07/23	Migraine advocacy	Bill Young, MD
04/21/23	Research methodology	Amy Gelfand, MD
05/05/23	Adult transition clinic	Ally Bazarsky, DO
05/19/23	Beyond fellowship: setting up a practice, headache program, consulting, etc.	William Qubty, MD
06/02/23	Journal club/reviewer/editor experience	Serena Orr, MD, MS
06/16/23	Hot topics in headache medicine	Madeline Chadehumbe, MD

Abbreviations: CBT, cognitive behavioral therapy; ED, emergency department; ICHD‐3, International Classification of Headache Disorders, 3rd edition; TACs, trigeminal autonomic cephalalgias. PTH, post traumatic headache; PPTH, persistent post traumatic headache, IIH, idiopathic intracranial hypertension, SIH, spontaneous intracranial hypotension,

Speaker recruitment

Lecture speakers were recruited through self‐identification or by invitation, with participation entirely voluntary. For recruitment of prospective speakers, IPHDS was described at various academic conferences and in the AHS Pediatric and Adolescent Headache Special Interest Group. ²⁰ Prospective speakers were encouraged to complete a speaker interest form. Twenty‐three speakers were then contacted to determine which pediatric headache medicine lecture topic they were best suited to speak on and their availability during the academic calendar year. Speakers were asked to complete a conflict‐of‐interest disclosure and to provide lecture slides 1 week prior to their scheduled lecture date.

Attendee recruitment

Information about IPHDS was advertised through channels such as the Dell Medical School Pediatric Headache Fellowship website, pediatric headache trainee listservs, the AHS's Headache Fellowship Program Directors' meetings, and open forums of other academic societies. Healthcare professionals interested in attending IPHDS were asked to complete a general interest form, and those who did were sent details about upcoming lectures throughout the academic calendar year.

Survey development

The Kirkpatrick Model was used to determine which method of assessment this curriculum innovation should administer. Level 1 of this model measures participants' self‐reported levels of competence using pre‐ and post‐surveys. ²¹ Pre‐ and post‐surveys were developed collaboratively by content experts, including pediatric headache specialists and clinical researchers, to ensure relevance of lecture content. The validation process involved iterative expert review to establish face and content validity. Likert scale anchors were explicitly defined in the survey instructions to facilitate consistent interpretation by respondents. The surveys were piloted with two individuals outside the study team to assess clarity and usability prior to deployment.

Data collection

Surveys were administered when attendees initially completed the general interest form (prior to any lecture attendance) and after the final lecture of the series had concluded. Demographic data, including attendees' clinical backgrounds and locations, was collected at each lecture. Data was analyzed using descriptive statistics.

Quantitative analysis

Quantitative data were analyzed using descriptive and inferential statistics. Normality of continuous variables was evaluated using the Shapiro–Wilk test (p > 0.05). Normally distributed variables are presented as mean ± standard deviation (SD), whereas non‐normally distributed variables are presented as median ± interquartile range (IQR). Statistical analysis was conducted in R (version 4.5.1) using only the base package. ²²

Qualitative analysis

Qualitative data were analyzed using conventional qualitative content analysis. Two reviewers independently and systematically examined all open‐ended responses to identify recurring patterns and develop preliminary categories. A third reviewer was available to resolve any discrepancies, although none arose. The final categories were then used to classify all responses.

RESULTS

Participant demographics

From July 2022 to July 2023, 23 biweekly lectures were delivered. Over 480 people signed up for IPHDS. Lecture attendees represented a variety of clinical backgrounds, including advanced practice providers (26.4%, n = 128/484), MD/DO headache providers (25.4%, n = 123/484), adult headache fellows (12.6%, n = 61/484), pediatric headache fellows (10.3%, n = 50/484), residents (8.1%, n = 39/484), clinical nurses (8.1%, n = 39/484), MD/DO neurology (non‐headache) providers (2.1%, n = 10/484), researchers (1.6%, n = 8/484), medical students (1.4%, n = 7/484), orofacial pain providers (1.0%, n = 5/484), psychologists (<1%, n = 3/484), pharmacists (<1%, n = 3/484), pain specialists (<1%, n = 2/484), pediatric hospital medicine fellows (<1%, n = 2/484), physical therapists (<1%, n = 2/484), a patient educator (<1%, n = 1/484), and a chiropractor (<1%, n = 1/484). Whereas the majority of attendees, 61.8% (n = 299/484), practiced in an academic center, 21.5% (n = 104/484) worked in a hospital‐based practice, 15.7% (n = 76/484) worked in private practice, <1% (n = 4/484) worked in government, <1% (n = 3/484) worked in research, and <1% (n = 1/484) worked in a nonprofit organization. Lecture attendees represented nine countries, including Australia, Brazil, Canada, El Salvador, Kuwait, the Philippines, Ukraine, the United Kingdom, and the United States. Within the United States, lecture attendees represented 31 states (Table 2).

TABLE 2.

Number of lecture attendees per state within the United States.

State	Number of lecture attendees
Alabama	2
Arizona	30
California	22
Connecticut	31
Delaware	1
Florida	12
Georgia	3
Hawaii	1
Illinois	3
Indiana	14
Iowa	6
Kansas	1
Kentucky	14
Louisiana	7
Massachusetts	10
Michigan	5
Minnesota	8
Mississippi	5
Missouri	3
Montana	15
Nevada	1
New York	11
North Carolina	16
Ohio	38
Oregon	3
Pennsylvania	13
Texas	99
Utah	27
Vermont	3
Virginia	3
Washington	1
Wisconsin	9

Lecture attendance

Median attendance for live lectures was 34.0 people [IQR: 28.3–42.5], and median viewership of the posted lectures to date was 79.0 views [IQR: 52.0–93.0]. Lectures on migraine pathophysiology, acute migraine management, inpatient management of headache disorders, and migraine preventative therapies had the highest attendance, with a mean of 59.8 people (SD ± 5.6). Meanwhile, lectures on migraine epidemiology, setting up a headache practice, and journal club had the lowest attendance, with a median of 25.0 people [IQR: 23.0–25.0].

Survey responses

Prior to attending IPHDS, only 56.7% (n = 230/406) of participants reported being competent or very competent in headache medicine, as indicated in their pre‐survey. After attending IPHDS, 76.9% (n = 40/52) of participants reported being competent or very competent in knowledge of headache medicine, as indicated in their post‐survey. Similarly, 78.8% (n = 41/52) of participants indicated that this didactic series moderately or significantly added to their knowledge of pediatric headache medicine. Twenty‐nine attendees answered an open‐ended question asking about what they enjoyed about this curricular innovation. The responses fell into three categories: lecture topics and speakers, connection with others, and lecture format (Table 3).

TABLE 3.

Post‐survey response categories and representative quotes about what lecture attendees enjoyed about the International Pediatric Headache Didactic Series.

Response category	Representative quote
Lecture topics and speakers	“The speakers and content were absolutely incredible, and the Q&A afterward was equally beneficial. I am so grateful for all that was shared, it has made a huge impact on my practice and confidence as a new headache‐focused provider.” “The topics were all so interesting and the presenters were fantastic!! Each lecture felt like a gold mine of knowledge and clinical pearls.” “Hearing lectures from headache specialists from around the US and world.”
Connection with others	“Feeling of connection with other specialists” “Being able to see world class experts in the field of pediatric headache medicine who are passionate about what they do everyday, and give their perspectives of it.” “Great collaboration and viewpoints outside of my academic bubble.” “Hearing what other practices are doing”
Didactic format	“I think the topics were well chosen, speakers were excellent, and I'm glad the videos were available.” “I enjoyed the online format.”

DISCUSSION

IPHDS successfully delivered free pediatric headache education to healthcare professionals worldwide. Healthcare professionals report that expense is the biggest barrier to CME. ¹⁶ Although CME credit was not offered during the first year of IPHDS (the period evaluated in this study), the series' no‐cost format helped eliminate financial barriers for healthcare professionals looking to further their medical education. CME accreditation was introduced in subsequent years, which may further engagement in future iterations. Lectures delivered via Zoom ensure that healthcare professionals can attend this didactic series regardless of their location. Because the lectures are posted on an open‐access website, healthcare professionals who cannot attend the live lectures can access this pediatric headache education at their convenience. The recordings remain available for repeated viewing, and lectures from previous years continue to receive ongoing viewership.

IPHDS attendees represented a variety of clinical backgrounds. Lecture attendees were primarily healthcare professionals at various stages in the medical training pipeline. Although the specific clinical specialties of the participants were not collected, the majority of lecture attendees were non‐headache faculty, suggesting that non‐headache healthcare professionals have a strong interest in comprehensive pediatric headache medicine. Therefore, pediatric headache education developed by fellowship‐trained pediatric headache specialists should be offered to all medical students, residents, and healthcare professionals who serve the pediatric population. ¹⁵ This will ensure that healthcare professionals at all levels are able to effectively diagnose headache disorders and provide optimal management to children. ⁶ , ⁷ , ⁸ , ¹⁵

The vast shortage of fellowship‐trained pediatric headache specialists extends far beyond the United States. ⁸ This scarcity may largely be attributed to the lack of headache education in the medical training pipeline. ⁸ , ¹⁰ Lecture speakers and attendees represented nine different countries, illustrating the need for free headache education around the world.

Lectures on the pathophysiology and management of headache disorders had the highest attendance. This demonstrates the subset of pediatric headache education that healthcare professionals are most interested in learning about. This aligns with the conceptual framework derived from ASD‐2030, which posits that promoting the education of healthcare professionals in the management of primary headache is key to adequately addressing headache disorders globally. ¹⁵ Lectures on headache practices and journal club had the lowest attendance. This is in part because most lecture attendees were non‐headache faculty; thus, these lectures were not relevant to their practice.

The overall impact of the series on attendees' self‐reported competence was measured through pre‐ and post‐surveys. Formalized examinations were not conducted to preserve a low‐pressure learning environment. Prior research has shown that high‐stakes examinations can negatively impact mental health by creating stress and decreasing intrinsic motivation to learn. ²³ In previous courses teaching molecular neuroscience and neuropharmacology, instructors found that students had increased knowledge retention and increased interest in neuroscience material when formalized examinations were replaced with alternative assessments. ²³ Because IPHDS only utilized surveys assessing perceived level of competence, it is important to acknowledge that these measures of competence may not accurately capture knowledge acquisition. This limitation underscores the need for future, objective, low‐stakes knowledge evaluations to more accurately assess the impact of this didactic series. It is also important to acknowledge that the surveys were only piloted with two individuals, which may affect the reliability and validity of the instruments. Broad pilot testing could strengthen future evaluation tools.

After attending IPHDS, 76.9% (n = 40/52) of participants reported being competent or very competent in their knowledge of headache medicine, and 78.8% (n = 41/52) indicated that this didactic series moderately or significantly enhanced their knowledge of pediatric headache medicine. Although these outcomes are encouraging, they are based on self‐reported perceptions, which may not accurately reflect improvements in clinical competence or knowledge. One key limitation of this study is that only 10.7% (n = 52/484) of participants who completed the pre‐survey also completed the post‐survey. This low completion rate raises concerns about potential response bias. Specifically, those who felt more positive about the didactic series may have been more likely to complete the post‐survey, which could have led to an overestimation of the program's perceived impact. Consequently, these findings may not be representative of all attendees, limiting the generalizability of the results. Future studies should consider implementing strategies to increase post‐survey response rates, such as reminders or incentives, to ensure a more representative sample and more robust conclusions.

Despite these limitations, our findings highlight the potential value of prospective educational interventions in headache medicine. Although our outcomes were limited to self‐reported measures, they align with the broader literature supporting the impact of structured education on clinical practice. For instance, in Estonia, an educational model was developed and implemented to improve headache care delivered by general practitioners. ²⁴ General practitioners who attended the educational courses referred fewer patients to neurologic specialists, used more specific headache diagnoses, ordered fewer unnecessary diagnostic tests, and were more likely to initiate headache treatment. ²⁴ This suggests that targeted educational interventions—when rigorously evaluated—can lead to meaningful changes in provider behavior and patient care.

Furthermore, IPHDS serves as a valuable opportunity for healthcare professionals at various stages of medical training to foster connections and find mentorship with pediatric headache specialists. In a survey of members of the AHS, participants indicated that having a mentor in the field was the primary way they became interested in headache medicine. ²⁵ IPHDS participants echoed this sentiment, noting that they enjoyed the speakers' expertise and the sense of connection with specialists (Table 3). The biweekly lecture format of IPHDS creates a space for consistent interaction with leading pediatric headache specialists worldwide, augmented by reserved time for discussion and questions at the end of each lecture. This exposure is essential to promote the continued growth of providers currently in practice and to recruit and retain talent in pediatric headache medicine. ¹⁰

CONCLUSION

IPHDS successfully delivered free comprehensive pediatric headache education to healthcare professionals at all levels. By leveraging a virtual format with optional asynchronous learning, IPHDS can engage lecture attendees from a variety of clinical backgrounds worldwide. Furthermore, this series serves as a framework for other subspecialties. By replicating this novel curriculum innovation, other subspecialties can disseminate education from specialists in the field to all healthcare professionals who serve the target population. IPHDS continues on an annual basis, following the academic calendar year, and now holds CME accreditation. For more information on this year's IPHDS, please visit: https://dellmed.utexas.edu/education/academics/graduate‐medical‐education/pediatric‐headache‐fellowship/international‐pediatric‐headache‐didactic‐series.

AUTHOR CONTRIBUTIONS

Sara Pavitt: Conceptualization; investigation; writing – original draft; methodology; validation; visualization; writing – review and editing; formal analysis; project administration; data curation; supervision. Sruthi Ilangovan: Writing – original draft; writing – review and editing; formal analysis; data curation. Zoë Allen: Conceptualization; writing – review and editing; methodology; visualization; project administration. Samantha L. Irwin: Investigation; writing – original draft; writing – review and editing; methodology; formal analysis; data curation; supervision; project administration. Irene Patniyot: Conceptualization; investigation; writing – original draft; methodology; validation; visualization; writing – review and editing; formal analysis; project administration; data curation; supervision.

FUNDING INFORMATION

The authors declare that this research received no external funding.

CONFLICT OF INTEREST STATEMENT

Sara Pavitt is a site principal investigator (PI) on a clinical trial investigating rimegepant as an acute treatment in pediatric patients with migraine. She is a site sub‐investigator (SubI) investigating ubrogepant as an acute treatment in pediatric patients with migraine. She receives no salary support from these trials. She is a site PI for the Patient‐Centered Outcomes Research Insitute‐funded Responding with Evidence and Access to Childhood Headache study, for which she does receive salary support.

Samantha L. Irwin is a site PI on clinical trials investigating ubrogepant and atogepant in pediatric migraine. She is a site SubI investigating rimegepant in pediatric patients with migraine. She has received an honorarium from The Hospital for Sick Children for speaking at Grand Rounds in Toronto, Canada (2024) and travel support for the AHS Resident Education for Assessment and Care for Headache program (2024). In the last 24 months, she has received consulting income from Theranica, Pfizer, and Merz. Dr. Irwin is also on the editorial board for the Annals of the Child Neurology Society and Pediatric Neurology, for which she receives no income.

Sruthi Ilangovan, Zoë Allen, and Irene Patniyot have no conflicts of interest to disclose.