Guidelines for the organization of headache education in Europe: the headache school II

Abstract

In order to promote education on headache disorders, European Headache Federation (EHF) in conjunction with National Headache Societies organizes educational courses meeting uniform standards according to previous published guidelines. Based on six headache summer schools’ experience, an EHF subcommittee has reviewed these guidelines, and here the revised version is presented. The goals remain the same: quality courses that will attract physicians and neurologists seeking to increase their knowledge, skills, and understanding in the area of primary and secondary headache. Detailed guidelines, a day-to-day program, and a multiple-choice test battery have now been outlined. It is recommended to include practical sessions with patient interviews and hands-on demonstrations of non-pharmacological treatment strategies. For countries that want a ‘low cost’ education program, a Video School program of a similar scientific standard has been developed. To be certified for CME credits, patronage, and financial support from EHF, it is highly recommended to adhere to the suggested teaching strategies. We hereby aim to promote and professionalize the education in headache disorders and endorse the educational courses meeting uniform standards of excellence.

Introduction

According to its mission statement, one of the aims of the European Headache Federation (EHF) is to “educate Europe” about headache [1]. In line with this goal, EHF published in 2005 guidelines addressing key issues for organizers of headache schools under the patronage of EHF [2]. Since then, six headache schools have been organized (http://www.ehf-org.org) in Italy, Greece, Denmark, Azerbaijan, France, and Spain. A total number of 345 registrants have participated and hereof 89% were MD’s. The format, quality, and evaluations have continuously been evaluated by the participants and an EHF subcommittee, and on this basis these guidelines have been revised. The new version is presented here. New rules not only deal with financial support mainly but also with the applications from National Headache Societies.

As in the previous paper [2], a sample course outline, developed in accordance with the systematic guidelines presented in this paper, is given below, together with a check list for applicants (see Appendices 1, 2, and 3).

Teaching course format

Target of the guidelines

These guidelines are aimed at institutions, such as National Neurological and/or Headache Societies, European Neurological Societies or allied scientific organizations that are planning to organize headache teaching courses at postgraduate level.

Aim of the course

The aim of the course is to enable participants to gain knowledge, skills, and understanding in the area of primary and secondary headache as well as the organization of headache care, and thereby contribute to their personal and professional development. By the end of the course, they should have enhanced their clinical skills, including their capacity to interact appropriately with affected individuals. Ideally, this should translate into an enhanced quality of life for headache sufferers. The key aim is that the knowledge gained from the course can be applied in the participants’ various professional fields. The National Society/Research Group hosting the course will apply to the appropriate authorities, national or European, for continuous medical education (CME) credits. In this way, the participants will be attending a certified course that can be a contribution to the university career. The target audience may include general practitioners with special interest in headache, general neurologists, clinical pharmacologists, and internal medicine specialists; the course brochure specifying which of these is aimed at and planned accordingly. The teaching course must be specifically designed to help participants to:

• recognize the various clinical presentations of headache;

• become familiar with the “red flags” and “comfort signs” approach to diagnosing secondary headaches;

• understand the latest concepts in headache pathophysiology;

• develop treatment plans for helping patients with all aspects of their headache treatment needs;

• formulate a headache management “toolbox” for patients, incorporating acute and preventive treatment approaches;

• devise strategies in order to help patients understand headache treatment tactics and improve patient compliance with therapeutic plans [3];

• provide strategies and plans for organization of national headache care [4].

Topics

Each day of the course, which should cover both primary and secondary headaches, must incorporate both theory and practical teaching. The organizers should ensure that any slides used are kept as concise as possible, given that it takes at least 40–60 s to explain and understand a slide. Speakers must submit their slides in plenty of time so that they can be printed or downloaded on an electronic media (USB-stick, CD-ROM or website) and available for distribution, on a daily basis, during the course. Patient demonstrations and interviews by the participants in small groups (6–8 per group) in rotation are the best medium for practical training under qualified supervision of the lectures. Alternatively video recordings are valuable for presenting illustrated case reports on both simple and complex cases and for making sure that the participants retain the information given. Ten-minutes interview or video plus 10–15-min discussion time are usually enough to become familiar with a clinical history. At least two patient-demonstrations, two videos or hands-on demonstrations of non-pharmacological treatment strategies per day should be included in the program.

Venue

The course should preferably be organized in a hospital/university setting, providing optimal facilities for demonstrations of patients, non-pharmacological treatment strategies or research laboratories.

Duration of the course

The ideal/minimum duration of a course is 3 days with at least 6 h/day theoretical teaching. Concise 1-day courses can be organized under the supervision, or with the advice of the EHF, on condition that the recommended ratio of practical/theoretical teaching is respected. Due to the necessity of a minimal set of education (especially for general practitioner) we are currently working on a 6-h format Headache School that is the minimum for obtaining European and national CME credits.

Participants and structure of lectures

Overcrowded courses prevent the participants from interacting with the lecturers and clearly lower the general level of attention. Around 50 participants should be admitted, ideally divided into two or more parallel sections. The attention of the participants is negatively correlated with the length of the lecture. On the basis of prevailing experience, duration of 20–25 min (+5 min for questions) is recommended. The course program should schedule 7–8 teaching hours per day (approximately 15 lectures/case reports). A key element in courses of this kind is the practical demonstrations, patient interviews, panel discussion or discussion groups, which should never be missing from the program. Participants have to be neurologists, general physicians, or psychiatrists or ophthalmologist or ENT (either registrants or young fellows) with a general knowledge on headache field or which to get one. Participants have to be either beginners or with a general knowledge on headache field.

Teaching staff

The course should provide participants with an opportunity to share in the experience of international scientists and to exchange opinions and ideas. A 3-day course should have a teaching staff of 3–5 foreign lecturers (local finances permitting), who should each be given the opportunity to give at least two lectures and demonstrate patient interviews. The local organizers will give the remaining lectures and organize the patient demonstrations and the practical treatment sessions. The discussion at the end of each lecture or at the end of a session gives all the participants an opportunity to express their ideas, considerations, second thoughts, etc. Therefore, each session should have at least two chairmen, whose role is to raise controversial issues and questions, requesting the speaker to express his own personal opinion, or international opinion, on certain topics.

Official language

The official language of the course should possibly be English; in certain situations, national languages can be used, provided that students or doctors are offered simultaneous translation.

Teaching material

Slide handouts and relevant scientific publications including state of the art reviews for each major topic selected by the lecturer as well the EHF-guidelines for the management of common headache disorders in general practice [3] should be available at the beginning of the course, either in paper or electronic format. The course material should also include brief curriculum vitae of each lecturer. The EHF secretariat may eventually help the local congress organizer in the assembling of the teaching material and e-mail that to the local secretariat.

Evaluation test and diploma

A standardized multiple choice questionnaire should be filled in by each participant at the beginning and at the end of the course. The evaluation test should include 2–3 questions relating to each lecture. The test results will be mailed to the participants after the course if requested. The EHF may provide an evaluation questionnaire if requested by the organizers. In order to gain CME credits, the participant should attend 80% of the scheduled activity. CME should be based on European authorities mainly and if the organizers suggest to national as well. All participants will receive a personal diploma, where the name, the objective, and the CME credits are displayed. The participants will also be asked to give their evaluation of the speakers and lecturers,

Miscellaneous

The course format should be included in the preliminary and final program brochure. In order to be formally approved by the EHF, the course format should be mailed to the president of the European Headache Federation who will distribute the application to the federation’s board members for approval. The EHF may offer financial support covering registration and accommodation to 2–3 participants from each country included in the developing countries list [5] with limited local funding after a written recommendation from their national EHF-representative.

The local organizing committee and the course chairman are fully responsible for promoting and marketing the course locally. EHF distributes the program via the website and mails directly to the national representatives at least 2–3 months in advance. The EHF congress secretariat may help the local congress company with logistical organization if requested.

The EHF can, upon request, provide the following material:

• IHS classification slide kit;

• evaluation test;

• standard 3-day program (see Appendix 2);

• currently available teaching materials (booklets, manuscripts, guidelines, patient brochures, etc.);

• diploma.

Applications

• 1. A complete program and a preliminary budget for European Schools should be submitted and approved by EHF board at least 6 months before announcement. After approval, the EHF logo and the EHF patronage should appear clearly on the program.

• 2. The national EHF representative should add a letter of recommendation of each candidate for the EHF grant together with the application.

• 3. The organizing national headache society (or societies) is fully responsible for the finances and EHF only secure the academic standard and support with the present grants according to the rules mentioned above (for the EHF responsibilities please see Appendix 3).

Headache Video School

Besides the frontal headache education described in the present document, the previous version of the guidelines for organizing a headache school needs to be updated on the basis of new media education technologies. The EHF has recently collected all the lectures presented at the European Headache School held in Mallorca on 12–14 March 2009 in a DVD. Such material is the core for a Video School available on request from countries that want a ‘low cost’ education program to be held. Therefore, a video school format has been constructed providing approximately 3-h video teaching (with a local chairman) and 1-h online discussion with an international chairman two times a day for 3 days. The advantage of such school for the applying country are: low cost for local organizers (no cost for speakers), excellence of the faculty, participation of a larger number of local doctors than those who are able to attend a school abroad (i.e. 2–3 per country on EHF finances). A fast-band internet connection (ADSL) should be checked well in advance for online discussion at the end of each session.

The request of such school material to the EHF is free until October 2010. After that date, due to the necessity of updating/replacing some lectures, a small royalty needs to be payed to the EHF. The request for the European Headache Video school has to be directed to the EHF president. Due to the necessity of a minimal set of education (especially for general practitioner), we are currently working on a 6-h format Headache School that is the minimum for obtaining European and national CME credit (see above). Information for frontal and video headache school is constantly updated at EHF web site [6].

Concluding remarks

In order to promote education on the very prevalent headache disorders, EHF organizes and endorses educational courses meeting uniform standards of excellence. Based on recent summer schools’ valuable experience, the guidelines have been revised and updated. A detailed review and validation process is planned after five additional headache schools. The primary goals to increase knowledge, skills, and understanding of headache disorders are emphasized. Likewise, organization of headache care, education, and research are important key elements to be implemented in future summer schools.

Appendices

Appendix 1: Checklist of European Headache Federation requirements for the organization of a teaching course on headache

• 1. Title of the teaching course:

• 2. Date:

• 3. City:

• 4. Chairman of the scientific committee:

• 5. Institution:

• 6. E-mail/fax:

• 7. Congress venue:

• 8. Number of participants:

• 9. Parallel sections:

• 10. Number of foreign lecturers:

• 11. Duration of the course:

• 12. Duration of the lectures:

• 13. Daily practical/theoretical teaching:

• 14. Telematic media:

• 15. Application for CME-points:

• 16. Multiple-choice evaluation test:

• 17. Handout material requested:

• 18. Official language:

• 19. Guidelines provided with course material:

• 20. Preliminary program submitted:

• 21. Diploma:

• 22. Budget:

• 23. Notes:

Appendix 2: Sample format of a 3-day headache course:

Local organization for the study of headache in conjunction with European Headache Federation presents:

• Title of the course

• International school on headache and related disorders

• Venue, city

• Day 1–3 month, year

Day 1

08.30–10.30 Introduction to headaches

08.30 Welcome and test

08.45 Classification of Headache

09.00 Epidemiology and burden of headache

09.30 Taking the headache history with patient demonstrations (group sessions)

10.30–11.00 Coffee break

11.00–13.00 Migraine I

11.00 Classification of migraine

11.30 Pathophysiology of migraine

12.00 Clinical picture of migraine

12.30 Complications of migraine

13.00 Lunch

14.30–16.30 Migraine II

14.30 Patient or video-case demonstrations

15.30–16.00 Comorbidities of migraine

15.30–16.00 Acute drug treatment

16.30–17.00 Coffee break

17.00–18.00 Prophylactic drug treatment

Day 2

08.30–10.30 Tension-type headache (TTH)

08.30 Classification and clinical picture of TTH

09.00 Epidemiology and burden of TTH

09.30 Pathogenesis of TTH

10.00 Comorbidities of TTH

10.30–11.00 Coffee break

11.00–13.00 Tension-type headache II

11.00 Pharmacological treatment of TTH

11.30 Non-pharmacological treatment of TTH

12.00 Temporomandibular dysfunction and headache

12.30 Medication-overuse headache

13.00–14.00 Lunch

14.30–16.30 Various I

14.30 Patient or video-case demonstrations

15.00 Cervicogenic and other secondary headaches

15.30 Headache in the emergency department

16.00–16.30 Coffee break

16.30–18.00 Various II

16.30 Other primary headaches

17.00 Cranial neuralgias

17.30 Which examinations in headache

Day 3

8.30–10.30 Trigeminal autonomic cephalalgias (TACs)

08.30 Epidemiology and classification of TACs

09.00 Pathogenesis of TACs

09.30 Clinical picture of TACs with patient or video-case demonstration

10.00 Pharmacological treatment of TACs

10.30–11.00 Coffee break

11.00–13.00 TACS II and other

11.00 Paroxysmal hemicrania and other TAC’s: clinical picture, differential diagnosis, and treatment

11.30 Post-traumatic headache, high and low pressure headaches in relation to other secondary headaches: clinical picture, differential diagnosis, and treatment

12.30–13.30 Lunch

14.00–16.30 Various III

14.00 Headache in the elderly: diagnosis and treatment

14.30 Headache in children: diagnosis and treatment

15.00 Headache and reproductive life

15.30–16.30 Test and evaluation

Appendix 3: EHF responsibilities

• Complete list of headache schools participants, programs, tests, diplomas, and applications for CME grants will be kept in EHF available for future organizers.

• EHF intends to sponsor the registration and accommodation of a maximum of ten European doctors, and a maximum of 2–3 doctors from each country.

• A headache school subcommittee, consisting of three members from the EHF executive committee (including the treasurer), evaluates the EHF-grant applications independently of the organizers.

• The EHF grant is maximum 600 Euros per person and is restricted to cover registration, and accommodation up to three nights during the Headache School. No economical support is provided for transportation expenses.

• The EHF is not responsible for the administrative issues connected with the organization of the Headache school. The economical support is granted, provided the criteria are satisfied.

• The EHF grant should only be reimbursed from EHF after the Headache School and after the participation has been confirmed by the organizers. The reimbursement should be directed from EHF to the organizers, not to the individuals.

• A complete review of the summer schools, the test results, and evaluations should be kept in EHF available for future organizers, and a summary should be available on the EHF website [6] and in the EHF news [6].