by James Watson, MD, Consultant, Departments of Neurology and Anesthesiology Mayo Clinic Rochester, MN

& Kevin Vorenkamp, MD, Director, Pain Medicine Fellowship Department of Anesthesiology & Pain Medicine Virginia Mason Medical Center Seattle, WA

Section Editor: Andrea Nicol, MD

Head and facial pain are common complaints seen by primary care physicians and neurologists and are a common source of referrals to pain medicine specialists. Unfortunately, formal headache training is limited in pain fellowships, and there is paucity of qualified pain medicine physicians who are comfortable assessing and treating these conditions. Although some of the most successful procedures in interventional pain medicine—for example, trigeminal ganglion radiofrequency ablation, third occipital neurotomy—may be indicated for head and facial pain, there are even fewer interventional pain physicians who are adequately trained and comfortable performing these procedures. Headache is recognized as a distinct subspecialty of Neurology with well recognized national societies (American Headache Society, National Headache Foundation). However, their annual meetings cater to noninterventional headache specialists. Headache management, as pertinent to the pain practitioner, is unique as compared to the neurologist or the primary care physician.

There is a need to promote cross talk among the various interventional and noninterventional headache specialists, to improve the headache education in pain medicine fellowships and to develop and standardize the indications, approaches, and techniques for headache pain management interventions. A headache special interest group in ASRA will allow pain management specialists to define and prioritize the educational, practice, and research needs pertinent to a pain medicine practice. Additionally, it may facilitate dissemination of new information and publications relevant to ASRA members with interest in these areas of pain medicine.

This statement of need, expressed by several ASRA members, facilitated the establishment of the ASRA Headache Special Interest Group (HA-SIG). The ASRA board approved the establishment of the HA-SIG in July 2014, and the first meeting was conducted on November 15, 2014, at the 13th Annual Pain Medicine Meeting in San Francisco, California. Nearly 20 members have expressed interest in founding and promoting the HA-SIG’s mission. Although the overall goals of the HASIG may evolve as the group gains additional input and exposure, the stated goals are as follows:

1. Promote the exchange and sharing of new information, ideas, and innovations concerning interventions and treatments for headache syndromes among the various interested multidisciplinary specialists in headache (pain management specialists, neurologists, and psychiatrists).

2. Define pain fellowship headache learning objectives from the point of view of a multidisciplinary group of pain management specialists with expertise and interest in headache.

3. Develop curricular resources for common headache syndromes and headache interventions pertinent to the pain management specialist.

4. Sponsor an educational module yearly at ASRA’s Annual Pain Medicine meeting.

5. Standardize the indications, approaches, and techniques for headache-related pain management procedures and, in the long term, to develop interventional headache practice recommendations.

6. Identify current gaps in clinical headache research and encourage clinical outcomes research of pain management headache interventions.

The group discussed different ways of sharing information among members of the HA-SIG with future intentions to reach out to other societies for sharing information. Currently, the HA-SIG has a dedicated page on the ASRA website. The HA-SIG also is evaluating methods whereby members can communicate privately within the group, post/share documents (eg, meeting planning, agenda, minutes), assign tasks, and discuss issues relevant to the HA-SIG. The other avenue for sharing information with members interested in headache-related topics is through the Pain Resource Center on the newly updated ASRA website. Currently, the only articles pertaining directly to the HA-SIG are on the topics of trigeminal neuralgia and cervicogenic headache, leaving a wide array of topics yet to be covered.

The HA-SIG also expressed the desire to work with the Annual Pain Medicine Meeting Scientific/Education Planning Committee to provide recommendations and suggestions for topics at the annual fall scientific meeting. Furthermore, mechanisms by which the HA-SIG itself could direct an educational symposium as part of the annual meeting were discussed.

Finally, in the spirit of ASRA’s mission of “advancing the science and practice of regional anesthesia and pain medicine,” the group felt that providing a structured curriculum of key topics in the management of head and facial pain is essential for practicing pain physician, fellows, and residents. Through collaborative work, this could be expanded to create formal and evidence-based practice guidelines for the interventional treatment of head and face pain.

The HA-SIG is looking for your input and is actively seeking additional members interested in contributing to the development of these ideas.

HOW CAN I JOIN THE HA-SIG? Members are able to join the Headache SIG when they join or renew their ASRA membership. Current ASRA members can join at any time by contacting Membership Services at 855-795-ASRA or by e-mail: asramembership@asra.com.

HOW MUCH DOES IT COST TO JOIN THE HA-SIG? It’s free! There is no additional charge to ASRA members in the inaugural year. You can register for this and other SIGs when you join or renew your membership.

WHEN WILL THE HA-SIG NEXT MEET? The HA-SIG will meet at the 14th Annual Pain Medicine Meeting, which is taking place November 19–21, 2015, at the Fontainebleau Miami Beach in Miami, Florida.

HOW CAN I PROVIDE INPUT TO THE HA-SIG PRIOR TO THE FALL MEETING? Feedback and suggestions related to the HA-SIG can be directed to hasig@asra.com.

We look forward to your input and participation in growing this component of ASRA for the benefit of patients and their dedicated physicians.