The Quality of Headache Treatment in The United States: Review and Analysis of Recent Data


  • Elizabeth W. Loder MD,

  • Fred Sheftell MD

  • From the Spaulding Rehabilitation Hospital, Headache Program, Boston, MA (Dr. Loder); and New England Center for Headache, Stamford, CT (Dr. Sheftell).

Address all correspondence to Dr. Elizabeth W. Loder, Spaulding Rehabilitation Hospital, Headache Program, 125 Nashua Street, Boston, MA 02114.


The methods and results of a recent large study of the quality of health care in the United States are reviewed with special emphasis on findings specific to headache care. The study's implications for educational and quality improvement efforts in the headache field are considered. These include (i) the need to teach and reinforce fundamental history-taking and physical-examination processes at all levels of medical education; (ii) the importance of recognizing serious problems of underuse and misuse of proven evaluation and treatment technologies; (iii) the desirability of shifting educational resources from simple messages that have been adequately absorbed toward more nuanced and targeted educational goals; and (iv) the value of novel and unorthodox educational strategies. Professional headache societies need to devote considerable resources to address the problem of widespread and important deficiencies in simple, fundamental care processes for headache.