It can be pretty annoying what so many doctors don't know. But then step back a second and consider just how much they need to know about so many different things.

In the UK, a doctors training consists of three years which are mainly spent in the medical school followed by another two years hospital based training. After that there is specialization training with the doctor ending up as a GP, surgeon, etc...

This is not a lot of time for most doctors to get to grips with something as rare as CH.

Most people with CH are likely to first see their GP, who is a General Practitioner, pretty much a jack of all trades and a master of none. With something like CH they are there to direct the patient to a neurologist.

Similarly if a patient first presents at the ER (A&E) then they will be seen be a similarly skilled person who just needs to direct them to a neurologist.

So we are down to the skill level of a neurologist. With how rare CH is, most will only ever see a handful of patients at the most, so perhaps one every few years. Little wonder that most get directed to those who specialize in headaches who will get to see a few a year.

This also backs up why we suggest that people see a headache specialist...

Medical education in headache
Posted 9/26/07, MEDSCAPE   

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Abstract statements from a study of headache education in medical programs. Second para. specific to neurological residency training. Gives good idea of why it's difficult to find a sharp doc.
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"Objective. To explore the extent of headache education received by medical students and residents.
Background. Headache is a common, often severe, and sometimes disabling problem. However, 49% of sufferers do not seek professional treatment -- of those who do, only 28% are very satisfied. One possible reason is limited education of physicians about headache.
Methods. Surveys were sent to all allopathic and osteopathic medical schools, 200 family medicine residencies, and all 126 neurology residencies. Information requested included the amount and perceived adequacy of headache education and any plans to increase headache education.
Results. Response rates were 35% to 40%. MEDICAL SCHOOL LECTURE HOURS RANGED FROM 0 (4%) TO >5 (24%) WITH 92% HAVING NO PLANS FOR AN INCREASE IN HEADACHE EDUCATION. FAMILY MEDICINE RESIDENCY LECTURE HOURS RANGED FROM 1-3 (30%) TO >5 (34%) AND CASE PRESENTATIONS FROM 1-5 (23%) TO >5 (41%), WITH 88% OF PROGRAM DIRECTORS HAVING NO PLANS FOR INCREASE. NEUROLOGY RESIDENCY LECTURE HOURS RANGED FROM 1-3 (11%) TO >5 (64%) AND CASE PRESENTATIONS FROM 1-5 (23%) TO >10 (57%), WITH 80% HAVING NO PLANS FOR INCREASE.
Conclusion. Undergraduate medical education in headache is limited. Despite medical schools perceiving their training as adequate, both neurology and family practice residency program directors believe entering residents are inadequately prepared in headache upon entering the program."

"Neurology Residency Programs
Neurology residency program lecture hours varied from 1 to 3 hours (11%) to >5 hours (64%) (Figure 2). The number of case presentations ranged from 1-5 (23%) to >10 (57%) (Figure 6). Forty-two (95%) of program directors believed that their headache education was adequate (Figure 4). Interestingly, 20% of neurology programs indicated plans to increase training in headache management. Similar to the family practice programs, 68% of the program directors believed that new residents had inadequate knowledge about headaches upon entering the program while only 11% of the program directors believed that their residents were well informed about headache."
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Education in schools and in docs lives after they are established in practice is affected by two major factors:
Medicine is an inherently conservative enterprise; forces of change are slow to influence practice. Second, given the enormous range of complex disorders they must understand/treat, their attention will be focused on those conditions which are most common coming in the door. (This is a major factor the the amazing growth in specialities and sub-specialities--no one can know everything. In the U.S., prior to 1900, medical education was commonly a local doc who took on a few "students" and gave them textbook education on the side. Medical schools/education, as we know it, didn't come into being until my grandparents' generaton!)

That's the history. You can respond by trying to find a doc who is open to receiving medical information from YOU. We can provide mainline medical literature which you can give to your (receptive,we hope!) so that they can learn how to more effectively treat us.

This issue is the primary reason we keep banging on the idea: locate a headache specialist, if at all possible.

We can't change the system which has given us this situation but we can become proactive in our own service.

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