To assess headache medicine knowledge and needs of pain specialists.

Migraine remains an underdiagnosed and undertreated primary headache disorder. One out of 10 seek care for migraine with a pain specialist. Pain specialists are much more likely to interface with headache patients who use opioids (75% of patients) compared to neurologists and headache specialists.

A cross-sectional anonymous self-reported survey was distributed (7/17/20-8/21/20) via email listserv among members of the American Academy of Pain Medicine. The survey was based on a prior survey on primary care providers’ knowledge and needs and was iteratively updated by four headache specialists, two with pain medicine affiliations.

The 105 respondents were 20.0 ± 13.6 years (mean±SD) in practice, 34.6% were female, and 71.4% were physicians. The most common specialty was anesthesia (36.1%, n=35/97) followed by neurology (14.4%, n=14/97).  About half (55.7%, n=34/61 and 53.3%, n=32/60) were familiar with the Â鶹´«Ã½Ó³»­ Guidelines for pharmacological treatment for migraine prevention and with the Choosing Wisely Campaign recommendations for limiting neuroimaging and opioid prescriptions. Less than half (39.7%, n=23/58) were familiar with the American Headache Society guidelines for management of migraine in an emergency setting. Providers were aware of the Level A evidence-based nonpharmacological therapies, with over three-fourths recognizing cognitive behavioral therapy (80.7%, n=50/62) and biofeedback (75.8%, n=47/62) as evidence-based interventions. Regarding clinical practice, almost 80% of providers (n=50/64) estimate making migraine diagnoses in <50% of their headache patients. Providers would consider starting preventive headache therapy at 7.1± 3.9 days/month. On average, providers referred 34.3%±34.2% of patients to behavioral interventions.