{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T07:33:38Z","timestamp":1793000018095,"version":"4.5.0"},"reference-count":45,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives\/Background<\/jats:title>\n                    <jats:p>Our objectives were to characterize the geographic distribution and local availability of United Council for Neurologic Subspecialties\u2010certified headache specialists across US counties, hospital referral regions, and states, and to examine associations with socioeconomic deprivation, social vulnerability, and urbanicity. Headache disorders are highly prevalent and disabling, yet local availability of certified headache subspecialty care in the United States remains uneven. Although prior studies have described national and state\u2010level distributions of United Council for Neurologic Subspecialties\u2010certified headache specialists, important gaps remain in understanding county\u2010level availability and disparities in access. Prior state\u2010level summaries may mask within\u2010state differences in access to United Council for Neurologic Subspecialties\u2010certified headache specialists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross\u2010sectional geospatial workforce analysis of United Council for Neurologic Subspecialties\u2010certified headache specialists in the United States as of January 7, 2026. Practice locations were mapped to counties, hospital referral regions, and states, and compared with general neurologist supply from the National Provider Identifier registry. Estimated population need was calculated by applying a national migraine prevalence to adult population denominators. We examined associations between specialist distribution and county\u2010level socioeconomic vulnerability, urbanicity, and region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3144\u2009US counties, 2870 (91.3%) had no United Council for Neurologic Subspecialties\u2010certified headache specialists, and 2085 (66.3%) had no neurologists. Headache specialists were entirely absent from counties without neurologists. Median county\u2010level headache specialist density was 0 per 100,000 adults, reflecting the absence of local subspecialty care in most US counties. Accounting for county adult population, neurologist density, urbanicity, and region, higher Area Deprivation Index and Social Vulnerability Index scores were associated with lower headache specialist rates. Each 10\u2010point increase in Area Deprivation Index was associated with lower expected headache specialist rate (adjusted incidence rate ratio\u2009=\u20090.87, 95% confidence interval\u2009=\u20090.82\u20130.93), and each 0.1\u2010unit increase in Social Vulnerability Index was also associated with lower expected rate (adjusted incidence rate ratio\u2009=\u20090.94, 95% confidence interval\u2009=\u20090.90\u20130.98). Headache specialist availability relative to estimated population need varied markedly across counties, with substantial estimated local differences between migraine burden and certified subspecialty supply that were not apparent in state\u2010level summaries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>United Council for Neurologic Subspecialties\u2010certified headache specialists are unevenly distributed across the United States, with limited local availability of certified headache subspecialty care in socioeconomically disadvantaged and nonmetropolitan counties. County\u2010level analyses identified substantial local gaps in certified headache subspecialty availability that were not apparent in state\u2010level summaries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.70197","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T09:05:29Z","timestamp":1787216729000},"page":"2006-2019","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Geographic variation in certified headache subspecialty availability in the United States"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6507-1967","authenticated-orcid":false,"given":"Bradley","family":"Ong","sequence":"first","affiliation":[{"name":"Department of Neurology, Neurological Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Cleveland Clinic  Cleveland Ohio USA"},{"name":"Neurological Institute Center for Outcomes Research &amp; Evaluation Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neurological Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amaal J.","family":"Starling","sequence":"additional","affiliation":[{"name":"Department of Neurology Mayo Clinic Arizona  Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2858-1639","authenticated-orcid":false,"given":"Nan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California, Irvine  Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.1640"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32160-7"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-024-01834-y"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-023-01699-7"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000214035"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2022.100415"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000011276"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.12406"},{"key":"e_1_2_10_10_1","unstructured":"United Council for Neurologic Subspecialties. 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