Improving Headache Care through Specialized Education: A Cross-Sectional Global Perspective

Improving Headache Care through Specialized Education: A Cross-Sectional Global Perspective | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Improving Headache Care through Specialized Education: A Cross-Sectional Global Perspective Lucia Jimena Zavala, Henrik Winther Schytz, Rigmor Højland Jensen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7204741/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Headache disorders affect 40% of the global population but remain underdiagnosed and undertreated. Limited access to specialized care highlights the need for structured educational programs to improve healthcare professionals’ expertise. This study evaluated the impact of a 2 year academic program, the Master of Headache Disorders (MHD) from the University of Copenhagen on graduates’ careers, clinical engagement, and educational needs. An anonymous online survey was sent to 88 MHD graduates (2018–2024), assessing career trajectories, clinical involvement, and academic experiences. Eighty respondents (91% response rate) from 36 countries participated. Most were female (63%), aged 35–44 (43%), and from diverse professional backgrounds: neurologists (52.5%), nurses (12.5%), physiotherapists (6.25%), pharmacists (1.25%), osteopaths (3.75%), neurosurgeons (1.25%), odontologists (2.5%), and others (16.25%). After graduation, 69% remained active in headache care and 90% regularly disseminated headache knowledge (38% monthly, 24% weekly). Career advancement was reported by 96%, with 47% receiving salary increases. Additionally, 28% of master’s theses led to clinical or research projects, 7% were published, and 23% planned publication. Structured headache education fosters professional growth, clinical engagement, and global knowledge dissemination. Expanding access to such programs may help reduce the global headache burden. Further studies should assess long-term clinical outcomes. Health sciences/Health care Health sciences/Medical research Health sciences/Neurology Biological sciences/Neuroscience Headache Education Master of Headache Disorders Figures Figure 1 Figure 2 1. Introduction Headache disorders are among the most prevalent and disabling neurological conditions worldwide, affecting approximately 40% of the global population and causing significant economic burdens. ( 1 ) They rank third among neurological disease burden by disability-adjusted life years (DALYs), following stroke and dementia.( 2 ) A major barrier to adequate headache care is the lack of formal headache education and training for healthcare professionals.( 4 ) Many medical doctors lack the skills for accurate diagnosis, leading to delays and inadequate treatment.( 5 , 6 ) As an example, 72% of migraine patients referred to specialized centers had not been correctly diagnosed beforehand. ( 7 ) Despite this, brief educational interventions have shown promise in improving diagnostic accuracy and patient outcomes.( 3 , 4 ) Strategic educational initiatives by international headache organizations could supplement local academic programs, which depend on each country's political and economic strategies.( 8 ) Smaller studies on headache education have positively affected clinical outcomes. ( 3 , 4 , 9 ) and basic training in headache management also improves accuracy and patient care. ( 10 )The University of Copenhagen’s Master of Headache Disorders (MHD) program, established in 2016, offers a comprehensive two-year part-time curriculum covering epidemiology, research, clinical management, and organizational skills. ( 11 )( 12 ) To date, 88 students have graduated, making it a leading academic headache education program. ( 9 ) Even though the informal feedback from graduates has been positive, it is of great importance to measure the possible impact of a program of this dimension on healthcare professionals' careers. This study aimed to evaluate the MHD program on graduates' career progression, work status, and educational needs. 2. Methods Standard Protocol Approvals, Registrations, and Patient Consents This study involved a questionnaire and did not require ethical approval from an institutional review board (IRB) in Denmark, as it was deemed low-risk. Informed consent was obtained from all participants, which was implied by their completion of the questionnaire. Participants were informed beforehand that by submitting their responses, they were consenting to participate in the study and that their responses would be treated confidentially. All methods were performed in accordance with the relevant guidelines and regulations. Survey Design and Administration This observational cross-sectional study surveyed MHD graduates from 2018 to 2024. The anonymous voluntary online questionnaire, distributed via Google Forms between July and October 2024, included 35 questions covering demographics, professional background, workplace setting, career impact, and scientific involvement. A reminder was sent at two and four weeks to improve response rates. A pilot version was conducted to assess clarity and relevance, and validation was achieved through internal review and testing to ensure suitability for the target audience. The complete survey is available in the supplementary material. Questionnaire Structure The structured questionnaire consisted of 35 questions covering the following key areas: Demographics: gender, age, country of origin, and graduation year. Education and Professional Background: highest level of education attained before the MHD program, current profession, and their involvement in headache-related education or clinical services. Workplace and Clinical Involvement: Type of organization (e.g., public hospital, private clinic) and number of headache patients they evaluate monthly. Career Impact: Effect of the MHD degree on career promotions, salary increases and establishing headache services. Scientific Engagement: participation in headache-related research, including clinical trials, systematic reviews, meta-analyses, and thesis publication. The questionnaire used various response formats such as multiple-choice, Likert scales, and open-ended questions. Certain questions allowed for more detailed qualitative feedback, particularly regarding suggestions for improving the MHD program. The questionnaire was administered electronically via Google Forms and was distributed to MHD graduates. Participants were informed that their responses would be kept confidential. The average time to complete the survey was approximately 10 minutes. Statistical Analysis Descriptive and observational analyses were conducted to summarize the survey responses. Data were collected from completed electronic questionnaires administered via Google Forms. Categorical variables (e.g., gender, workplace type) were analyzed using frequency counts and percentages, while continuous variables (e.g., age, number of headache patients seen) were analyzed using measures of central tendency and dispersion. Likert scale responses were presented as frequency distributions, with medians and interquartile ranges calculated for non-normally distributed data. Open-ended responses were analyzed qualitatively using thematic analysis. This involved systematically reviewing the text data to identify recurring themes, patterns, and key concepts expressed by the graduates. The geographic distribution of graduates was visualized using a world map, where dot size corresponded to the number of graduates from each country. 3. Results Demographics The survey had a 91% response rate (80 graduates). The participants were graduates from different years (MHD 1–4), increasing participation from MHD1 in 2018 17 (21%) to MHD4 in 2024 (27%). Most respondents were female (63%) and aged 35–44 (43%). Graduates represented 36 countries, with Scandinavia accounting for 23%. (Fig. 1 ) Education and Professional Background Before enrolling in the MHD program, most participants held a bachelor’s or master’s degree (31.2% and 32.5%, respectively) They came from various professional backgrounds, including neurologists 52.5%, nurses 12.5%, physiotherapists 6.25%, pharmacists 1.25%, osteopaths 3.75%, neurosurgeons 1.25%, and odontologists 2.5%. Some of the responders had other or two professions 16.25%. 3.1 Career Impact After graduation, 69% continued to engage in headache-related activities and 90% shared their knowledge with others. In total, 38% of the participants dedicated monthly time, and 24% weekly. A total of 96% reported career advancement, with 47% also experiencing a salary increase. After graduation, 42% transitioned into headache clinics, while 23% had already established a headache service. Additionally, 53% expressed an interest in establishing a headache service in the future. 3.2 Scientific Engagement 28% refer their master thesis resulted in a clinical or research study, or a national guideline and 7% had published their Master thesis in a peer-reviewed journal, while 23% planned to do so. 58% participate on headache research, 72% of them participate on clinical trials, systematic reviews, and original research studies. We asked them multiple questions about their motivation for completing the master's, and 95% answered that they wanted to gain more knowledge and expertise in headaches. 56% said the program aligned with their career aspirations, and 45% were impressed by its faculty and reputation. The results are summarized in a Flow chart (Fig. 2 ). 4. Discussion This study demonstrates that the MHD program supports graduates’ career progression and sustained engagement in headache care, including clinical practice, education, and research. Nearly half of graduates have transitioned into specialized headache clinics or established new services, highlighting the program’s practical impact. The findings support the value of structured education in improving headache management worldwide. The persistent dissemination of headache knowledge by 90% of graduates suggests a multiplier effect in headache education worldwide. These findings align with prior research indicating that improved formal education can enhance diagnostic accuracy and patient outcomes. ( 3 , 4 ) The Master in Headache Disorders (MHD) is a two-year, part-time program delivered through a blended learning format, combining virtual coursework with face-to-face sessions, including a mandatory three-week clinical rotation. The curriculum covers a comprehensive range of topics such as headache epidemiology, pathophysiology, clinical diagnosis, differential diagnosis, treatment modalities, and headache management guidelines. In addition, students engage in research methodology and are required to complete and defend a research thesis, promoting evidence-based practice. This program has demonstrated a significant impact on participants’ clinical competence and confidence in headache diagnosis and management. Its flexible design allows healthcare professionals worldwide to maintain their clinical practice while advancing their expertise, fostering a multiplier effect in headache education. The MHD’s replicable structure serves as a model for enhancing headache education and improving patient outcomes on a global scale.( 11 ) Despite the significant burden of headache disorders, formal headache education is limited at the undergraduate and graduate levels.( 13 , 14 ) Enhancing headache medical education is crucial for its economic, social, and epidemiological impact.( 13 , 15 ) Many people with headaches are not diagnosed or treated correctly due to a lack of knowledge about the disorder, which is a primary clinical barrier. Challenges vary by country income and health care systems, but adequate treatment options and guidelines are often not followed.( 5 , 16 ) Low- and middle-income countries face challenges such as limited access to care, insufficient professional education, inadequate health policies, and a lack of specialized headache centers.( 17 ) In contrast, high-income countries also struggle with the low priority given to headache disorders and a persistent deficit in headache education at all levels, including undergraduate medical training. ( 18 ) A survey across multiple European countries found that improper management and specialist referrals in chronic migraine patients may lead to underdiagnosis and undertreatment. ( 13 , 20 ) Differences in headache management between general practitioners and neurologists also contribute. Delays such as more than 4-year wait time between migraine diagnosis and preventive treatment initiation. ( 5 ) The up to six-year delay in cluster headache diagnosis leads to misinformation and unnecessary treatments. ( 21 ) This delay may stem from insufficient education, unawareness of guidelines, and prevention efficacy. ( 6 , 20 , 22 , 23 ) The general population often does not perceive headache disorders as serious since they are mostly episodic, non-fatal, and non-contagious. Low consultation rates in developed countries suggest many affected people are unaware of effective treatments, with half estimated to be self-treating. ( 2 , 15 )Governments aiming to constrain healthcare costs may not recognize the burden of headaches on society, missing the potential indirect cost savings from reduced lost productivity, absenteeism, and improved quality of life. ( 13 ) This observational cross-sectional study has multiple strengths worth highlighting. First, it is the first study of its kind, with a high response rate, international scope, and interdisciplinary representation. Secondly, this study evaluates a detailed two-year headache-accredited educational program, allowing us to observe and analyze the program's effectiveness over time. The extended duration offers valuable insights into the long-term impact of such a program, which has not been addressed before. Despite initial concerns that time constraints might limit healthcare providers' participation, we observed a high involvement rate (80 out of 88 participants), underscoring the significance and engagement this topic generates among professionals. Notably, 90% of the graduates keep transmitting their knowledge to new generations. This makes us think this educational program keeps participants motivated through the years, and the knowledge could be spread. This study demonstrated that 42% of the graduates transitioned to a specialized headache clinic position, and 23% opened their own headache clinic and 53% intend to establish a headache service. This indicates this program's profound impact on their professional roles and careers, ultimately benefiting the global health systems and interest in applying their education directly into clinical practice. It is essential to acknowledge some limitations when interpreting this study's findings. Firstly, while we are impressed with the involvement of 80 participants, we cannot translate these results to another program as it is unique, which could limit the generalizability of the findings. Additionally, the questionnaire relies on self-reported data, which could be affected by recall bias. As our study is cross-sectional, it does not fully capture the long-term impact on clinical practices. Conclusions This study highlights the value of structured education in improving headache care. The MHD program has contributed to career advancement, increased clinical engagement, and scientific dissemination. However, long-term research is needed to assess the sustained impact on patient outcomes. Understanding this is essential for optimizing headache education, which could improve clinical outcomes, reduce the burden of headaches, and reduce their indirect economic impact on society. By addressing the educational needs of healthcare providers, we can enhance their ability to manage headache disorders effectively, ultimately leading to better patient care and quality of life. Declarations Competing Interests The authors declare L Zavala is a part-time lecturer of the Master of Headache Disorders. HW Schytz is a professor at the University of Copenhagen, the Codirector of the Master of Headache Disorders, and part of the Board of Education of the Danish Headache Society. RH Jensen she has given lectures for Abvie, Lundbeck, Pfizer, and Teva; serve as investigator in clinical trials with NovoNordisk and Lundbeck; is the director of the Danish Headache Center, Lifting The Global Burden of Headache and Founder of Master of Headache Disorders at University of Copenhagen; and has received research funding from Lundbeck Foundation, NovoNordisk Foundation and University of Copenhagen. Data Availability: The data supporting the findings of this study are available upon reasonable request from the corresponding author. Due to privacy and ethical considerations, individual responses from the anonymous survey are not publicly accessible. Author Contributions: RHJ: Research project: Conception and Organization. Statistical Analysis: Review and critique; Manuscript preparation: Review and Critique. HWS: Research project: Conception and Organization; Statistical Analysis: Review and critique; Manuscript preparation: Review and Critique. LZ: Research Project Conception, Organization, Execution. Statistical Analysis: Design and Execution. Manuscript preparation: Writing the first draft. Funding Sources and Conflict of Interest: No specific funding was received for this work. The authors declare L Zavala is a part-time lecturer of the Master of Headache Disorders. HW Schytz is a professor at the University of Copenhagen, the Codirector of the Master of Headache Disorders, and part of the Board of Education of the Danish Headache Society. RH Jensen she has given lectures for Abvie, Lundbeck, Pfizer, and Teva; serve as investigator in clinical trials with NovoNordisk and Lundbeck; is the director of the Danish Headache Center, Lifting The Global Burden of Headache and Founder of Master of Headache Disorders at University of Copenhagen; and has received research funding from Lundbeck Foundation, NovoNordisk Foundation and University of Copenhagen. Ethical Compliance Statement We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this work complies with its guidelines. The authors confirm that informed consent was obtained from all participants, which was implied by completion of the anonymous questionnaire. References Stewart, W. F., Wood, G. C., Razzaghi, H., Reed, M. L. & Lipton, R. B. Work Impact of Migraine Headaches. J Occup Environ Med [Internet]. ;50(7):736–45. (2008). Available from: http://www.jstor.org/stable/44997585 Steiner, T. J. Lifting the burden: the global campaign against headache. Lancet Neurol. 3 (4), 204–205 (2004). Braschinsky, M. et al. Structured education can improve primary-care management of headache: the first empirical evidence, from a controlled interventional study. Journal of Headache and Pain [Internet]. ;17(1):1–7. (2016). Available from: http://dx.doi.org/10.1186/s10194-016-0613-1 Karli, N., Zarifoglu, M., Erer, S., Pala, K. & Akis, N. The Impact of Education on the Diagnostic Accuracy of Tension-Type Headache and Migraine: A Prospective Study. Cephalalgia [Internet]. ;27(1):41–5. (2007). Available from: https://doi.org/10.1111/j.1468-2982.2006.01245.x Viana, M. et al. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort. Eur J Neurol [Internet]. ;27(3):536–41. (2020). Available from: https://doi.org/10.1111/ene.14098 Tfelt-Hansen, P. & Steiner, T. J. Over-the-Counter Triptans for Migraine. CNS Drugs [Internet]. ;21(11):877–83. (2007). Available from: https://doi.org/10.2165/00023210-200721110-00001 Owens, C., Pugmire, B. & Owens, K. A Migraine Prophylaxis Educational Intervention in a Medicaid Population. Headache: The Journal of Head and Face Pain [Internet]. ;48(2):267–71. (2008). Available from: https://doi.org/10.1111/j.1526-4610.2007.01012.x Frich, J. C., Kristoffersen, E. S. & Lundqvist, C. GPs’ experiences with brief intervention for medication-overuse headache: A qualitative study in general practice. Br. J. Gen. Pract. ; 64 (626). (2014). Braschinsky, M. et al. Structured education to improve primary-care management of headache: how long do the benefits last? A follow-up observational study. Eur J Neurol [Internet]. ;25(3):497–502. (2018). Available from: https://doi.org/10.1111/ene.13524 Lala, N. & Martelletti, P. P064. 12 years of Master Degree in Headache Medicine at Sapienza University of Rome. J. Headache Pain ; 16 (S1). (2015). Master in. Headache Disorders [Internet]. [cited 2025 Mar 26]. Available from: https://mhd.ku.dk/ VanderPluym, J. H., Mead-Harvey, C. & Starling, A. J. Pressing Issues Among Trainees and Early Career Physicians in Headache Medicine: Survey Results From the American Headache Society New Investigator and Trainee Section and International Headache Academy. Headache ; 60 (4). (2020). Steiner, T. J. et al. Headache service quality: the role of specialized headache centres within structured headache services, and suggested standards and criteria as centres of excellence. J Headache Pain [Internet]. ;20(1):24. (2019). Available from: https://doi.org/10.1186/s10194-019-0970-7 Finkel, A. G. American academic headache specialists in neurology: practice characteristics and culture. Cephalalgia [Internet]. ;24(7):522–7. (2004). Available from: https://doi.org/10.1111/j.1468-2982.2003.00703.x WHO V. Atlas of headache disorders and resources in the world 2011 [Internet]. World Health Organization, editor. Genève: Världshälsoorganisationen. 2011 [cited 2025 Mar 26]. 0–69 p. Available from: https://www.who.int/publications/i/item/9789241564212 Do, T. P. et al. Barriers and gaps in headache education: a national cross-sectional survey of neurology residents in Denmark. BMC Med. Educ. ; 22 (1). (2022). Mortel, D., Kawatu, N., Steiner, T. J. & Saylor, D. Barriers to headache care in low- and middle-income countries. Vol. 29, eNeurologicalSci. (2022). Gallagher, R. M., Alam, R., Shah, S., Mueller, L. & Rogers, J. J. Headache in Medical Education: Medical Schools, Neurology and Family Practice Residencies. Headache: The Journal of Head and Face Pain [Internet]. ;45(7):866–73. (2005). Available from: https://doi.org/10.1111/j.1526-4610.2005.05155.x Ahmed, Z. A. & Faulkner, L. R. Headache Education in Adult Neurology Residency: A Survey of Program Directors and Chief Residents. Headache: The Journal of Head and Face Pain [Internet]. ;56(5):871–7. (2016). Available from: https://doi.org/10.1111/head.12822 Katsarava, Z., Mania, M., Lampl, C., Herberhold, J. & Steiner, T. J. Poor medical care for people with migraine in Europe – evidence from the Eurolight study. J Headache Pain [Internet]. ;19(1):10. (2018). Available from: https://doi.org/10.1186/s10194-018-0839-1 Frederiksen, H. H., Lund, N. L. T., Barloese, M. C. J., Petersen, A. S. & Jensen, R. H. Diagnostic delay of cluster headache: A cohort study from the Danish Cluster Headache Survey. Cephalalgia ; 40 (1). (2020). Latinovic R, Gulliford M, Ridsdale L. Headache and migraine in primary care: consultation,prescription, and referral rates in a large population. Journal of Neurology, Neurosurgery& Psychiatry [Internet]. 2006;77(3):385. Available from: http://jnnp.bmj.com/content/77/3/385.abstract. Veenstra, P., Kollen, B. J., de Jong, G., Baarveld, F. & van den Berg, J. S. P. Nurses improve migraine management in primary care. Cephalalgia [Internet]. ;36(8):772–8. (2015). Available from: https://doi.org/10.1177/0333102415612767 Additional Declarations Competing interest reported. The authors declare L Zavala is a part-time lecturer of the Master of Headache Disorders. HW Schytz is a professor at the University of Copenhagen, the Codirector of the Master of Headache Disorders, and part of the Board of Education of the Danish Headache Society. RH Jensen she has given lectures for Abvie, Lundbeck, Pfizer, and Teva; serve as investigator in clinical trials with NovoNordisk and Lundbeck; is the director of the Danish Headache Center, Lifting The Global Burden of Headache and Founder of Master of Headache Disorders at University of Copenhagen; and has received research funding from Lundbeck Foundation, NovoNordisk Foundation and University of Copenhagen. Supplementary Files MasterofHeadacheDisorders.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 26 Mar, 2026 Reviews received at journal 11 Jan, 2026 Reviews received at journal 01 Jan, 2026 Reviews received at journal 23 Dec, 2025 Reviewers agreed at journal 21 Dec, 2025 Reviews received at journal 21 Dec, 2025 Reviewers agreed at journal 18 Dec, 2025 Reviewers agreed at journal 16 Dec, 2025 Reviewers agreed at journal 16 Dec, 2025 Reviewers agreed at journal 16 Dec, 2025 Reviewers invited by journal 16 Dec, 2025 Editor assigned by journal 17 Nov, 2025 Editor invited by journal 31 Jul, 2025 Submission checks completed at journal 29 Jul, 2025 First submitted to journal 29 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7204741","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":562485135,"identity":"7775b022-3c9e-49f5-924d-ab480a40c3b9","order_by":0,"name":"Lucia Jimena Zavala","email":"","orcid":"","institution":"Copenhagen University Hospital Rigshospitalet-Glostrup","correspondingAuthor":false,"prefix":"","firstName":"Lucia","middleName":"Jimena","lastName":"Zavala","suffix":""},{"id":562485136,"identity":"22971aa7-d46d-47bd-887a-cec13fa1909a","order_by":1,"name":"Henrik Winther Schytz","email":"","orcid":"","institution":"Copenhagen University Hospital Rigshospitalet-Glostrup","correspondingAuthor":false,"prefix":"","firstName":"Henrik","middleName":"Winther","lastName":"Schytz","suffix":""},{"id":562485138,"identity":"c1bb0826-ee76-4fa5-be7e-fb5cf44c7343","order_by":2,"name":"Rigmor Højland Jensen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYDACZhSqAsIEIQMitZwhRgsKYGyDG4Bbi3k7+9UNH/cwsPNLtz98XDjvnpy8O/OxxwUM1sa4tMgc5im7OeMZA7PknDPGxjO3FRsbHmZLN57BkG6GS4sEM0/abZ4DQHfcyGGT5t2WkLixmcdMmofhsA1BLfY30p//5p2TUE+EFvZjEFskEsyYeRsSEuSZIVrwOYzt5owDEswSN3KMpXmOJRhuYGZLk+YxSMfpfQn+489ufDhgk8w/I/3hZ56aBHn5/sPHpHkqrA0bcOlh4AFFgEQynG9wAEziVA8E7A9ApB2cL4/b9FEwCkbBKBihAAD/0kgQxGU7swAAAABJRU5ErkJggg==","orcid":"","institution":"Copenhagen University Hospital Rigshospitalet-Glostrup","correspondingAuthor":true,"prefix":"","firstName":"Rigmor","middleName":"Højland","lastName":"Jensen","suffix":""}],"badges":[],"createdAt":"2025-07-24 10:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7204741/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7204741/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98611966,"identity":"884fcf15-25ee-4dd1-99c9-bd93d6d4682e","added_by":"auto","created_at":"2025-12-19 14:46:07","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":374645,"visible":true,"origin":"","legend":"","description":"","filename":"ScientificReportrevised.docx","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/ac3003a3c940ec4210b01f4d.docx"},{"id":98611967,"identity":"6cb1f62c-1470-4fba-965e-85721357b9c1","added_by":"auto","created_at":"2025-12-19 14:46:07","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6107,"visible":true,"origin":"","legend":"","description":"","filename":"57c438fee3344c3294290125bf67eb90.json","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/d1fc9f31858ffa2b30f556b2.json"},{"id":98611977,"identity":"ad29181b-9f66-434c-8111-0493ddf7ac06","added_by":"auto","created_at":"2025-12-19 14:46:07","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":597600,"visible":true,"origin":"","legend":"","description":"","filename":"MasterofHeadacheDisorders.docx","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/241d85a53305560a4e0f3c8c.docx"},{"id":98628470,"identity":"587e8e52-04e1-46cc-b9dc-2164cadd29c6","added_by":"auto","created_at":"2025-12-19 17:11:35","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":59654,"visible":true,"origin":"","legend":"","description":"","filename":"57c438fee3344c3294290125bf67eb901enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/10e83c2e652f5dfcb4a3e5d5.xml"},{"id":98611969,"identity":"9f6ce2f5-ff2f-4b3f-ac90-8c2946f09645","added_by":"auto","created_at":"2025-12-19 14:46:07","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":75745,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/eadedb61a4220c82740fcd0c.png"},{"id":98628629,"identity":"1c20151d-c6ad-493d-a6ee-5dc1ac78cb38","added_by":"auto","created_at":"2025-12-19 17:11:54","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":122990,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/223ab5a2e31c8fe51e64ee8d.png"},{"id":98611975,"identity":"9b8b9397-383e-4a9c-af8e-2978beb9675d","added_by":"auto","created_at":"2025-12-19 14:46:07","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":24246,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/31dd94ccecb251846adae695.png"},{"id":98611973,"identity":"581e7b01-b9af-4d3b-b266-7b15066d636a","added_by":"auto","created_at":"2025-12-19 14:46:07","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":48621,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/79225ba8a546f91f8da0e35b.png"},{"id":98629120,"identity":"52e95801-917a-4389-9ddb-a58ab93b7c7b","added_by":"auto","created_at":"2025-12-19 17:13:16","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":53266,"visible":true,"origin":"","legend":"","description":"","filename":"57c438fee3344c3294290125bf67eb901structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/56166396be3c22b720af99ac.xml"},{"id":98629173,"identity":"b1fbdd9a-1f3b-4562-9657-63031a0ec118","added_by":"auto","created_at":"2025-12-19 17:13:21","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":67840,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/130cef255756d26bc4287955.html"},{"id":98611964,"identity":"42f84a8d-2370-45a6-a2d0-63a4cc253715","added_by":"auto","created_at":"2025-12-19 14:46:07","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59558,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGlobal distribution of the master students. 1-11 color scale max quantity in Denmark\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/65e9b288ae0fff9c3d8a9ecb.jpg"},{"id":98611965,"identity":"38ef344d-5125-4627-ad13-f4f5c210486f","added_by":"auto","created_at":"2025-12-19 14:46:07","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55452,"visible":true,"origin":"","legend":"\u003cp\u003eFlow Chart\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/ef30b02ea4a58657abe8767b.jpg"},{"id":98632186,"identity":"73c825ef-36bb-4b6a-8ba0-b233c87e1a5b","added_by":"auto","created_at":"2025-12-19 17:21:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":552547,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/9402bdab-611a-4721-81e7-28756cf8a22f.pdf"},{"id":98629483,"identity":"ff3489e8-8953-4737-8c3c-168e2089eaa3","added_by":"auto","created_at":"2025-12-19 17:14:02","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":597600,"visible":true,"origin":"","legend":"","description":"","filename":"MasterofHeadacheDisorders.docx","url":"https://assets-eu.researchsquare.com/files/rs-7204741/v1/236ac512074e1f34441b934a.docx"}],"financialInterests":"Competing interest reported. The authors declare \nL Zavala is a part-time lecturer of the Master of Headache Disorders. \nHW Schytz is a professor at the University of Copenhagen, the Codirector of the Master of Headache Disorders, and part of the Board of Education of the Danish Headache Society. \nRH Jensen she has given lectures for Abvie, Lundbeck, Pfizer, and Teva; serve as investigator in clinical trials with NovoNordisk and Lundbeck; is the director of the Danish Headache Center, Lifting The Global Burden of Headache and Founder of Master of Headache Disorders at University of Copenhagen; and has received research funding from Lundbeck Foundation, NovoNordisk Foundation and University of Copenhagen.","formattedTitle":"Improving Headache Care through Specialized Education: A Cross-Sectional Global Perspective","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHeadache disorders are among the most prevalent and disabling neurological conditions worldwide, affecting approximately 40% of the global population and causing significant economic burdens. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) They rank third among neurological disease burden by disability-adjusted life years (DALYs), following stroke and dementia.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA major barrier to adequate headache care is the lack of formal headache education and training for healthcare professionals.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Many medical doctors lack the skills for accurate diagnosis, leading to delays and inadequate treatment.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) As an example, 72% of migraine patients referred to specialized centers had not been correctly diagnosed beforehand. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Despite this, brief educational interventions have shown promise in improving diagnostic accuracy and patient outcomes.(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eStrategic educational initiatives by international headache organizations could supplement local academic programs, which depend on each country's political and economic strategies.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Smaller studies on headache education have positively affected clinical outcomes. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and basic training in headache management also improves accuracy and patient care. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)The University of Copenhagen\u0026rsquo;s Master of Headache Disorders (MHD) program, established in 2016, offers a comprehensive two-year part-time curriculum covering epidemiology, research, clinical management, and organizational skills. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) To date, 88 students have graduated, making it a leading academic headache education program. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eEven though the informal feedback from graduates has been positive, it is of great importance to measure the possible impact of a program of this dimension on healthcare professionals' careers. This study aimed to evaluate the MHD program on graduates' career progression, work status, and educational needs.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eStandard Protocol Approvals, Registrations, and Patient Consents\u003c/p\u003e \u003cp\u003eThis study involved a questionnaire and did not require ethical approval from an institutional review board (IRB) in Denmark, as it was deemed low-risk. Informed consent was obtained from all participants, which was implied by their completion of the questionnaire. Participants were informed beforehand that by submitting their responses, they were consenting to participate in the study and that their responses would be treated confidentially. All methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e \u003cp\u003eSurvey Design and Administration\u003c/p\u003e \u003cp\u003eThis observational cross-sectional study surveyed MHD graduates from 2018 to 2024. The anonymous voluntary online questionnaire, distributed via Google Forms between July and October 2024, included 35 questions covering demographics, professional background, workplace setting, career impact, and scientific involvement. A reminder was sent at two and four weeks to improve response rates. A pilot version was conducted to assess clarity and relevance, and validation was achieved through internal review and testing to ensure suitability for the target audience. The complete survey is available in the supplementary material.\u003c/p\u003e \u003cp\u003eQuestionnaire Structure\u003c/p\u003e \u003cp\u003eThe structured questionnaire consisted of 35 questions covering the following key areas:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDemographics: gender, age, country of origin, and graduation year.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEducation and Professional Background: highest level of education attained before the MHD program, current profession, and their involvement in headache-related education or clinical services.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWorkplace and Clinical Involvement: Type of organization (e.g., public hospital, private clinic) and number of headache patients they evaluate monthly.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCareer Impact: Effect of the MHD degree on career promotions, salary increases and establishing headache services.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eScientific Engagement: participation in headache-related research, including clinical trials, systematic reviews, meta-analyses, and thesis publication.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe questionnaire used various response formats such as multiple-choice, Likert scales, and open-ended questions. Certain questions allowed for more detailed qualitative feedback, particularly regarding suggestions for improving the MHD program. The questionnaire was administered electronically via Google Forms and was distributed to MHD graduates. Participants were informed that their responses would be kept confidential. The average time to complete the survey was approximately 10 minutes.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive and observational analyses were conducted to summarize the survey responses. Data were collected from completed electronic questionnaires administered via Google Forms. Categorical variables (e.g., gender, workplace type) were analyzed using frequency counts and percentages, while continuous variables (e.g., age, number of headache patients seen) were analyzed using measures of central tendency and dispersion. Likert scale responses were presented as frequency distributions, with medians and interquartile ranges calculated for non-normally distributed data. Open-ended responses were analyzed qualitatively using thematic analysis. This involved systematically reviewing the text data to identify recurring themes, patterns, and key concepts expressed by the graduates. The geographic distribution of graduates was visualized using a world map, where dot size corresponded to the number of graduates from each country.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eDemographics\u003c/p\u003e \u003cp\u003eThe survey had a 91% response rate (80 graduates). The participants were graduates from different years (MHD 1\u0026ndash;4), increasing participation from MHD1 in 2018 17 (21%) to MHD4 in 2024 (27%). Most respondents were female (63%) and aged 35\u0026ndash;44 (43%). Graduates represented 36 countries, with Scandinavia accounting for 23%. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eEducation and Professional Background\u003c/p\u003e \u003cp\u003eBefore enrolling in the MHD program, most participants held a bachelor\u0026rsquo;s or master\u0026rsquo;s degree (31.2% and 32.5%, respectively) They came from various professional backgrounds, including neurologists 52.5%, nurses 12.5%, physiotherapists 6.25%, pharmacists 1.25%, osteopaths 3.75%, neurosurgeons 1.25%, and odontologists 2.5%. Some of the responders had other or two professions 16.25%.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Career Impact\u003c/h2\u003e \u003cp\u003eAfter graduation, 69% continued to engage in headache-related activities and 90% shared their knowledge with others. In total, 38% of the participants dedicated monthly time, and 24% weekly. A total of 96% reported career advancement, with 47% also experiencing a salary increase. After graduation, 42% transitioned into headache clinics, while 23% had already established a headache service. Additionally, 53% expressed an interest in establishing a headache service in the future.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Scientific Engagement\u003c/h2\u003e \u003cp\u003e 28% refer their master thesis resulted in a clinical or research study, or a national guideline and 7% had published their Master thesis in a peer-reviewed journal, while 23% planned to do so. 58% participate on headache research, 72% of them participate on clinical trials, systematic reviews, and original research studies.\u003c/p\u003e \u003cp\u003eWe asked them multiple questions about their motivation for completing the master's, and 95% answered that they wanted to gain more knowledge and expertise in headaches. 56% said the program aligned with their career aspirations, and 45% were impressed by its faculty and reputation. The results are summarized in a Flow chart (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study demonstrates that the MHD program supports graduates\u0026rsquo; career progression and sustained engagement in headache care, including clinical practice, education, and research. Nearly half of graduates have transitioned into specialized headache clinics or established new services, highlighting the program\u0026rsquo;s practical impact. The findings support the value of structured education in improving headache management worldwide.\u003c/p\u003e \u003cp\u003eThe persistent dissemination of headache knowledge by 90% of graduates suggests a multiplier effect in headache education worldwide. These findings align with prior research indicating that improved formal education can enhance diagnostic accuracy and patient outcomes. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe Master in Headache Disorders (MHD) is a two-year, part-time program delivered through a blended learning format, combining virtual coursework with face-to-face sessions, including a mandatory three-week clinical rotation. The curriculum covers a comprehensive range of topics such as headache epidemiology, pathophysiology, clinical diagnosis, differential diagnosis, treatment modalities, and headache management guidelines. In addition, students engage in research methodology and are required to complete and defend a research thesis, promoting evidence-based practice.\u003c/p\u003e \u003cp\u003eThis program has demonstrated a significant impact on participants\u0026rsquo; clinical competence and confidence in headache diagnosis and management. Its flexible design allows healthcare professionals worldwide to maintain their clinical practice while advancing their expertise, fostering a multiplier effect in headache education. The MHD\u0026rsquo;s replicable structure serves as a model for enhancing headache education and improving patient outcomes on a global scale.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDespite the significant burden of headache disorders, formal headache education is limited at the undergraduate and graduate levels.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) Enhancing headache medical education is crucial for its economic, social, and epidemiological impact.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) Many people with headaches are not diagnosed or treated correctly due to a lack of knowledge about the disorder, which is a primary clinical barrier. Challenges vary by country income and health care systems, but adequate treatment options and guidelines are often not followed.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) Low- and middle-income countries face challenges such as limited access to care, insufficient professional education, inadequate health policies, and a lack of specialized headache centers.(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) In contrast, high-income countries also struggle with the low priority given to headache disorders and a persistent deficit in headache education at all levels, including undergraduate medical training. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eA survey across multiple European countries found that improper management and specialist referrals in chronic migraine patients may lead to underdiagnosis and undertreatment. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) Differences in headache management between general practitioners and neurologists also contribute. Delays such as more than 4-year wait time between migraine diagnosis and preventive treatment initiation. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) The up to six-year delay in cluster headache diagnosis leads to misinformation and unnecessary treatments. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) This delay may stem from insufficient education, unawareness of guidelines, and prevention efficacy. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) The general population often does not perceive headache disorders as serious since they are mostly episodic, non-fatal, and non-contagious. Low consultation rates in developed countries suggest many affected people are unaware of effective treatments, with half estimated to be self-treating. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)Governments aiming to constrain healthcare costs may not recognize the burden of headaches on society, missing the potential indirect cost savings from reduced lost productivity, absenteeism, and improved quality of life. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThis observational cross-sectional study has multiple strengths worth highlighting. First, it is the first study of its kind, with a high response rate, international scope, and interdisciplinary representation.\u003c/p\u003e \u003cp\u003eSecondly, this study evaluates a detailed two-year headache-accredited educational program, allowing us to observe and analyze the program's effectiveness over time. The extended duration offers valuable insights into the long-term impact of such a program, which has not been addressed before.\u003c/p\u003e \u003cp\u003eDespite initial concerns that time constraints might limit healthcare providers' participation, we observed a high involvement rate (80 out of 88 participants), underscoring the significance and engagement this topic generates among professionals. Notably, 90% of the graduates keep transmitting their knowledge to new generations. This makes us think this educational program keeps participants motivated through the years, and the knowledge could be spread. This study demonstrated that 42% of the graduates transitioned to a specialized headache clinic position, and 23% opened their own headache clinic and 53% intend to establish a headache service. This indicates this program's profound impact on their professional roles and careers, ultimately benefiting the global health systems and interest in applying their education directly into clinical practice.\u003c/p\u003e \u003cp\u003eIt is essential to acknowledge some limitations when interpreting this study's findings. Firstly, while we are impressed with the involvement of 80 participants, we cannot translate these results to another program as it is unique, which could limit the generalizability of the findings. Additionally, the questionnaire relies on self-reported data, which could be affected by recall bias. As our study is cross-sectional, it does not fully capture the long-term impact on clinical practices.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study highlights the value of structured education in improving headache care. The MHD program has contributed to career advancement, increased clinical engagement, and scientific dissemination. However, long-term research is needed to assess the sustained impact on patient outcomes.\u003c/p\u003e \u003cp\u003eUnderstanding this is essential for optimizing headache education, which could improve clinical outcomes, reduce the burden of headaches, and reduce their indirect economic impact on society. By addressing the educational needs of healthcare providers, we can enhance their ability to manage headache disorders effectively, ultimately leading to better patient care and quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cp\u003eThe authors declare L Zavala is a part-time lecturer of the Master of Headache Disorders. HW Schytz is a professor at the University of Copenhagen, the Codirector of the Master of Headache Disorders, and part of the Board of Education of the Danish Headache Society. RH Jensen she has given lectures for Abvie, Lundbeck, Pfizer, and Teva; serve as investigator in clinical trials with NovoNordisk and Lundbeck; is the director of the Danish Headache Center, Lifting The Global Burden of Headache and Founder of Master of Headache Disorders at University of Copenhagen; and has received research funding from Lundbeck Foundation, NovoNordisk Foundation and University of Copenhagen.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available upon reasonable request from the corresponding author. Due to privacy and ethical considerations, individual responses from the anonymous survey are not publicly accessible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRHJ: Research project: Conception and Organization. Statistical Analysis: Review and critique; Manuscript preparation: Review and Critique.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHWS: Research project: Conception and Organization; Statistical Analysis: Review and critique; Manuscript preparation: Review and Critique.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLZ: Research Project Conception, Organization, Execution. Statistical Analysis: Design and Execution. Manuscript preparation: Writing the first draft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Sources and Conflict of Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo specific funding was received for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe authors declare \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eL Zavala is a part-time lecturer of the Master of Headache Disorders.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHW\u0026nbsp;Schytz\u0026nbsp;is a professor at the University of Copenhagen, the Codirector of the Master of Headache Disorders, and part of the Board of Education of the Danish Headache Society.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRH\u0026nbsp;Jensen\u0026nbsp;she has given lectures for Abvie, Lundbeck, Pfizer, and Teva; serve as investigator in clinical trials with NovoNordisk and Lundbeck; is the director of the Danish Headache Center, Lifting The Global Burden of Headache and Founder of Master of Headache Disorders at University of Copenhagen; and has received research funding from Lundbeck Foundation, NovoNordisk Foundation and University of Copenhagen.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Compliance Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe confirm that we have read the Journal\u0026rsquo;s position on issues involved in ethical publication and affirm that this work complies with its guidelines.\u003c/p\u003e\n\u003cp\u003eThe authors confirm that informed consent was obtained from all participants, which was implied by completion of the anonymous questionnaire.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStewart, W. F., Wood, G. C., Razzaghi, H., Reed, M. L. \u0026amp; Lipton, R. B. Work Impact of Migraine Headaches. J Occup Environ Med [Internet]. ;50(7):736\u0026ndash;45. (2008). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.jstor.org/stable/44997585\u003c/span\u003e\u003cspan address=\"http://www.jstor.org/stable/44997585\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteiner, T. J. Lifting the burden: the global campaign against headache. \u003cem\u003eLancet Neurol.\u003c/em\u003e \u003cb\u003e3\u003c/b\u003e (4), 204\u0026ndash;205 (2004).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraschinsky, M. et al. Structured education can improve primary-care management of headache: the first empirical evidence, from a controlled interventional study. Journal of Headache and Pain [Internet]. ;17(1):1\u0026ndash;7. (2016). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1186/s10194-016-0613-1\u003c/span\u003e\u003cspan address=\"10.1186/s10194-016-0613-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarli, N., Zarifoglu, M., Erer, S., Pala, K. \u0026amp; Akis, N. The Impact of Education on the Diagnostic Accuracy of Tension-Type Headache and Migraine: A Prospective Study. Cephalalgia [Internet]. ;27(1):41\u0026ndash;5. (2007). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1468-2982.2006.01245.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1468-2982.2006.01245.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eViana, M. et al. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort. Eur J Neurol [Internet]. ;27(3):536\u0026ndash;41. (2020). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ene.14098\u003c/span\u003e\u003cspan address=\"10.1111/ene.14098\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTfelt-Hansen, P. \u0026amp; Steiner, T. J. Over-the-Counter Triptans for Migraine. CNS Drugs [Internet]. ;21(11):877\u0026ndash;83. (2007). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2165/00023210-200721110-00001\u003c/span\u003e\u003cspan address=\"10.2165/00023210-200721110-00001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOwens, C., Pugmire, B. \u0026amp; Owens, K. A Migraine Prophylaxis Educational Intervention in a Medicaid Population. Headache: The Journal of Head and Face Pain [Internet]. ;48(2):267\u0026ndash;71. (2008). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1526-4610.2007.01012.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1526-4610.2007.01012.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrich, J. C., Kristoffersen, E. S. \u0026amp; Lundqvist, C. GPs\u0026rsquo; experiences with brief intervention for medication-overuse headache: A qualitative study in general practice. \u003cem\u003eBr. J. Gen. Pract.\u003c/em\u003e ;\u003cb\u003e64\u003c/b\u003e(626). (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraschinsky, M. et al. Structured education to improve primary-care management of headache: how long do the benefits last? A follow-up observational study. Eur J Neurol [Internet]. ;25(3):497\u0026ndash;502. (2018). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ene.13524\u003c/span\u003e\u003cspan address=\"10.1111/ene.13524\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLala, N. \u0026amp; Martelletti, P. P064. 12 years of Master Degree in Headache Medicine at Sapienza University of Rome. \u003cem\u003eJ. Headache Pain\u003c/em\u003e ;\u003cb\u003e16\u003c/b\u003e(S1). (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaster in. Headache Disorders [Internet]. [cited 2025 Mar 26]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://mhd.ku.dk/\u003c/span\u003e\u003cspan address=\"https://mhd.ku.dk/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanderPluym, J. H., Mead-Harvey, C. \u0026amp; Starling, A. J. Pressing Issues Among Trainees and Early Career Physicians in Headache Medicine: Survey Results From the American Headache Society New Investigator and Trainee Section and International Headache Academy. \u003cem\u003eHeadache\u003c/em\u003e ;\u003cb\u003e60\u003c/b\u003e(4). (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteiner, T. J. et al. Headache service quality: the role of specialized headache centres within structured headache services, and suggested standards and criteria as centres of excellence. J Headache Pain [Internet]. ;20(1):24. (2019). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s10194-019-0970-7\u003c/span\u003e\u003cspan address=\"10.1186/s10194-019-0970-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFinkel, A. G. American academic headache specialists in neurology: practice characteristics and culture. Cephalalgia [Internet]. ;24(7):522\u0026ndash;7. (2004). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1468-2982.2003.00703.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1468-2982.2003.00703.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO V. Atlas of headache disorders and resources in the world 2011 [Internet]. World Health Organization, editor. Gen\u0026egrave;ve: V\u0026auml;rldsh\u0026auml;lsoorganisationen. 2011 [cited 2025 Mar 26]. 0\u0026ndash;69 p. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/9789241564212\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/9789241564212\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDo, T. P. et al. Barriers and gaps in headache education: a national cross-sectional survey of neurology residents in Denmark. \u003cem\u003eBMC Med. Educ.\u003c/em\u003e ;\u003cb\u003e22\u003c/b\u003e(1). (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMortel, D., Kawatu, N., Steiner, T. J. \u0026amp; Saylor, D. Barriers to headache care in low- and middle-income countries. Vol. 29, eNeurologicalSci. (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGallagher, R. M., Alam, R., Shah, S., Mueller, L. \u0026amp; Rogers, J. J. Headache in Medical Education: Medical Schools, Neurology and Family Practice Residencies. Headache: The Journal of Head and Face Pain [Internet]. ;45(7):866\u0026ndash;73. (2005). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1526-4610.2005.05155.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1526-4610.2005.05155.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed, Z. A. \u0026amp; Faulkner, L. R. Headache Education in Adult Neurology Residency: A Survey of Program Directors and Chief Residents. Headache: The Journal of Head and Face Pain [Internet]. ;56(5):871\u0026ndash;7. (2016). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/head.12822\u003c/span\u003e\u003cspan address=\"10.1111/head.12822\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatsarava, Z., Mania, M., Lampl, C., Herberhold, J. \u0026amp; Steiner, T. J. Poor medical care for people with migraine in Europe \u0026ndash; evidence from the Eurolight study. J Headache Pain [Internet]. ;19(1):10. (2018). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s10194-018-0839-1\u003c/span\u003e\u003cspan address=\"10.1186/s10194-018-0839-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrederiksen, H. H., Lund, N. L. T., Barloese, M. C. J., Petersen, A. S. \u0026amp; Jensen, R. H. Diagnostic delay of cluster headache: A cohort study from the Danish Cluster Headache Survey. \u003cem\u003eCephalalgia\u003c/em\u003e ;\u003cb\u003e40\u003c/b\u003e(1). (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLatinovic R, Gulliford M, Ridsdale L. Headache and migraine in primary care: consultation,prescription, and referral rates in a large population. Journal of Neurology, Neurosurgery\u0026amp; Psychiatry [Internet]. 2006;77(3):385. Available from: http://jnnp.bmj.com/content/77/3/385.abstract.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVeenstra, P., Kollen, B. J., de Jong, G., Baarveld, F. \u0026amp; van den Berg, J. S. P. Nurses improve migraine management in primary care. Cephalalgia [Internet]. ;36(8):772\u0026ndash;8. (2015). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0333102415612767\u003c/span\u003e\u003cspan address=\"10.1177/0333102415612767\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Headache Education, Master of Headache Disorders","lastPublishedDoi":"10.21203/rs.3.rs-7204741/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7204741/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHeadache disorders affect 40% of the global population but remain underdiagnosed and undertreated. Limited access to specialized care highlights the need for structured educational programs to improve healthcare professionals’ expertise. This study evaluated the impact of a 2 year academic program, the Master of Headache Disorders (MHD) from the University of Copenhagen on graduates’ careers, clinical engagement, and educational needs.\u003cbr\u003e\n An anonymous online survey was sent to 88 MHD graduates (2018–2024), assessing career trajectories, clinical involvement, and academic experiences.\u003cbr\u003e\n Eighty respondents (91% response rate) from 36 countries participated. Most were female (63%), aged 35–44 (43%), and from diverse professional backgrounds: neurologists (52.5%), nurses (12.5%), physiotherapists (6.25%), pharmacists (1.25%), osteopaths (3.75%), neurosurgeons (1.25%), odontologists (2.5%), and others (16.25%). After graduation, 69% remained active in headache care and 90% regularly disseminated headache knowledge (38% monthly, 24% weekly). Career advancement was reported by 96%, with 47% receiving salary increases. Additionally, 28% of master’s theses led to clinical or research projects, 7% were published, and 23% planned publication.\u003cbr\u003e\n Structured headache education fosters professional growth, clinical engagement, and global knowledge dissemination. Expanding access to such programs may help reduce the global headache burden. Further studies should assess long-term clinical outcomes.\u003c/p\u003e","manuscriptTitle":"Improving Headache Care through Specialized Education: A Cross-Sectional Global Perspective","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-19 14:45:56","doi":"10.21203/rs.3.rs-7204741/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-26T19:32:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-11T10:00:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-01T09:33:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-24T01:57:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234501533534233571240713693589490213406","date":"2025-12-21T20:28:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-21T07:24:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108864316709834596833803272478088804259","date":"2025-12-18T15:25:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"318706341370156303821626350676118883240","date":"2025-12-16T15:26:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149913139768392630545273193531942749354","date":"2025-12-16T14:58:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64701182989457370542361470795160453245","date":"2025-12-16T13:14:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-16T13:03:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-18T04:54:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-31T10:42:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-29T08:03:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-07-29T08:00:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"48efd850-635d-4d84-a9e9-ef4078863997","owner":[],"postedDate":"December 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":59900683,"name":"Health sciences/Health care"},{"id":59900684,"name":"Health sciences/Medical research"},{"id":59900685,"name":"Health sciences/Neurology"},{"id":59900686,"name":"Biological sciences/Neuroscience"}],"tags":[],"updatedAt":"2025-12-19T14:45:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-19 14:45:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7204741","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7204741","identity":"rs-7204741","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}