Headache Medicine Fellowship

Overview of the Loyola Headache Medicine Fellowship

Headache medicine is a medical subspecialty concerned with the diagnosis and treatment of diseases or categories of disease involving the central and peripheral manifestations of disturbance to the structures of the head and face.

This includes primary and secondary disturbances of these structures or functions which present for clinical care in multiple specialty areas including primary care areas, such as family practice and general internal medicine, and specialty care areas including, but not restricted to neurology, neurosurgery, otolaryngology, physical medicine and rehabilitation, oromaxillofacial surgery and psychiatry.

For these disease management areas, the practitioner of headache medicine is often the principal care physician and may render all levels of care commensurate with this or his/her training.

Loyola Medicine and the Department of Neurology at Loyola University Chicago (LUC) Stritch School of Medicine is offering a one-year Headache Medicine Fellowship program focusing on management of headache disorders.

The fellowship is accredited by the United Council for Neurologic subspecialties (UCNS). The fellows will directly manage patients with headache disorders in outpatient and inpatient settings, and will participate in and conduct headache clinical research.

This opportunity is open to physicians with residency training in neurology, family medicine, internal medicine or emergency medicine and will focus on the clinical and research aspects related to headache disorders. Candidates should have excellent judgment, good work ethic, and interact well with peers and other medical and support personnel. Fellows will also have important roles in student and resident education.

Loyola University Chicago's Stritch School of Medicine has research institutes in neurosciences, cardiovascular, oncology, burn/shock/trauma, infectious disease, bioethics and health policy and education. Housed in the John & Herta Cuneo Center, Stritch occupies 110,000 square feet of state-of-the art classrooms, basic research labs and clinical research areas. More than 500 medical students and 500 residents are taught.

For information on compensation, benefits and plans, please contact the Loyola Medicine Graduate Medical Education Office.

Eligibility and Application Process

Applicants must meet the following requirements:

• The fellow must possess a current valid and unrestricted license to practice medicine in the United States or Canada or its territories.
• The fellow must be a graduate of a residency program in neurology or other specialties accredited by the ACGME or the Royal College of Physicians and Surgeons of Canada (RCPSC).
• The fellow must be board certified or eligible for certification in a primary ABMS or RCPSC specialty
• A graduate of medical schools in one of the following:
  • United States and Canada accredited by the Liaison Committee on Medical Education (LCME) or;
  • graduates of medical schools in the United States accredited by the American Osteopathic Association or;
  • graduates of medical schools outside the United States and Canada who have received currently valid certification of Education Commission for Foreign Medical Graduates (ECFMG).

Please send the following to the Program Director: 

• Current Photo
• Curriculum Vitae
• Official copy of your medical school transcript
• Dean's letter
• Three letters of recommendation ( you may initially email me the information; please have your writers send the original copy to the address below)
• Personal statement
• Copies of USMLE Step 1, USMLE Step 2 CK and USMLE Step 2 CS examination scores or COMLEX Step 1 COMLEX Step 2 CK, and USMLE Step 2 CS examination scores
• Copy of your current, active license
• ECFMG Certificate (if applicable)

Program Director Contact Information

Athena Kostidis, MD 
Clinical Assistant Professor of Neurology 
Program Director, Headache Medicine Fellowship

2160 S. First Avenue, Building 105/2700 
Maywood, IL 60153

Email: AKostidis@lumc.edu

Program Goals and Objectives

Patient Care

Provide family-centered patient care that is development- and age-appropriate, compassionate, and effective for the treatment of health problems and the promotion of health.

1. Develop the ability to efficiently, and accurately evaluate adult and pediatric patients with headache disorders by further developing history taking with emphasis on headache history, and master physical examination skills, with emphasis on neurological examination.
2. Develop a rational approach to the use of laboratory tests and neuroimaging in the evaluation of adult and pediatric patients with headache disorders.
3. Interpret test-related diagnostic tools to reach a correct diagnosis and thereby provide appropriate treatment.

Medical Knowledge

Understand the scope of established and evolving biomedical, clinical, epidemiological and social-behavioral knowledge needed by a headache physician; demonstrate the ability to acquire, critically interpret and apply this knowledge in patient care.

1. Gain knowledge of the peripheral and central anatomy of the trigeminovascular system.
2. Gain knowledge of the modulation of head pain in the central nervous system, the neuronal phenomenon of cortical spreading depression, and the pathophysiology and neurobiology of migraine.
3. Become familiarized with the ICHD-II of the International Headache Society.
4. Become able to interpret warning signs and symptoms which rule in secondary headache disorders.
5. Become familiarized with acute conditions leading to headache such as subarachnoid hemorrhage, temporal arteritis, dural sinus thrombosis, carotid or vertebral dissection, spontaneous intracranial hypertension, CNS infections, reversible cerebral vasoconstriction syndrome, etc.
6. Become able to outline a differential diagnosis in patients present with either acute or chronic headache.
7. Become able to identify subtypes of migraine, such as migraine with aura, hemiplegic migraine, retinal migraine, basilar migraine, etc.
8. Become familiar with the epidemiology and the genetics of migraine
9. Become familiar with principles of allodynia and its relevance to the treatment of migraine.
10. Become familiar with the pathophysiology and the neurobiology of migraine and other primary headache disorders such as Cluster, trigeminal autonomic cephalalgias (TACs), etc.
11. To demonstrate skills in patient education of headache disorders, including pathophysiology and treatment.
12. Discuss mechanism of action, pharmacokinetics, side effects, and toxicities of migraine specific medications such as triptans and ergot alkaloids.
13. Develop an appropriate treatment strategy for acute migraine patients based on evidence-based guidelines.
14. Discuss the use of preventive medications based on evidence, indications, contraindications, drug interactions, and side effects profile
15. Become familiar with non-pharmacological migraine treatment approaches, including biofeedback and behavioral therapies.
16. Describe indications for hospitalization and discuss various treatment approaches for refractory migraine or status migrainosus.
17. Discuss potentical complications of migraine, including Migrainous infarctions, migraine-triggered epilepsy, the controversy on patent foramen ovale, and the association with oral contraceptive use.
18. Discuss headache disability scales include MIDAS and HIT-6, and the indication for referral to multidisciplinary chronic pain rehabilitation centers.
19. Discuss other primary headache disorders, including tension headaches and the comorbities associated with their chronicity.
20. Discuss treatment options for chronic tension headache.
21. Describe cluster headache and distinguish it from other TACs.
22. Discuss an approach to develop treatment plans for patients with episodic and chronic cluster headaches and other TACs
23. Discuss indications and demonstrate ability to perform lumbar punctures.
24. Discuss indications for botulinum toxin injections and learn its administration technique.
25. Describe the indications and technique of occipital nerve block in headache disorders.
26. Describe the presentation of pediatric patients with precursors and equivalents of migraine
27. Discuss treatment strategies for primary headache disorders in children.
28. Expand knowledge in the field of neuroimaging, pain medicine, and neuro-ophthalmology.
29. Develop familiarity and competency in headache research methods.
30. Formulate a hypothesis in relation to the disorder and conduct a research study.
31. Present the results of one or more headache research proposals at a regional/national meeting.
32. Submit one or more research papers to a peer review journal.

Interpersonal Skills and Communication

Demonstrate interpersonal and communication skills that result in information exchange and partnering with patients, their families and professional associates.

1. Provide effective patient education, including reassurance, for a condition(s) common to this subspecialty area.
2. Communicate effectively with referring physicians, other health professionals, and health-related agencies in a timely manner to create and sustain information exchange and teamwork for patient care.
3. Promote interaction with disciplines which are complementary to Headache Medicine
4. Maintain accurate, legible, timely and legally appropriate medical records, including referral forms and letters, for subspecialty patients in the outpatient and inpatient setting.
5. Acquire skills in oral presentation of research studies and didactic material.

Practice-based Learning and Improvement

Demonstrate knowledge, skills and attitudes needed for continuous self-assessment, using scientific methods and evidence to investigate, evaluate, and improve one's patient care practice.

1. Identify standardized guidelines for diagnosis and treatment of conditions common to headache medicine and adapt them to the individual needs of specific patients.
2. Identify personal learning needs related to headache medicine; systematically organize relevant information resources for future reference; and plan for continuing acquisition of knowledge and skills.

Professionalism

Demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to diversity.

1. Demonstrate personal accountability to the well-being of patients (e.g., following up on lab results, writing comprehensive notes, and seeking answers to patient care questions).
2. Demonstrate a commitment to carrying out professional responsibilities.
3. Adhere to ethical and legal principles, and be sensitive to diversity.

Systems-based Practice

Understand how to practice high-quality health care and advocate for patients within the context of the health care system.

1. Identify key aspects of health care systems as they apply to specialty care, including the referral process, and differentiate between consultation and referral.
2. Demonstrate sensitivity to the costs of clinical care in this subspecialty setting, and take steps to minimize costs without compromising quality
3. Recognize and advocate for families who need assistance to deal with systems complexities, such as the referral process, lack of insurance, multiple medication refills, multiple appointments with long transport times, or inconvenient hours of service.
4. Recognize one's limits and those of the system; take steps to avoid medical errors.