Guidelines for the organization of headache education in Europe: the headache school II
© Springer-Verlag 2010
Received: 9 November 2009
Accepted: 26 January 2010
Published: 24 February 2010
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.
According to its mission statement, one of the aims of the European Headache Federation (EHF) is to “educate Europe” about headache . In line with this goal, EHF published in 2005 guidelines addressing key issues for organizers of headache schools under the patronage of EHF . 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 , 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
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 ;
provide strategies and plans for organization of national headache care .
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.
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.
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.
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.
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  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,
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  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.
IHS classification slide kit;
standard 3-day program (see Appendix 2);
currently available teaching materials (booklets, manuscripts, guidelines, patient brochures, etc.);
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.
The national EHF representative should add a letter of recommendation of each candidate for the EHF grant together with the application.
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 .
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.
Conflict of interest
- Gerber WD, Antonaci F (eds) (2000) Directory of the European Headache Centres & Yellow Pages. EDIMES, Pavia, p 1192Google Scholar
- Antonaci F, Lainez JM, Diener HC, Couturier EGM, Agosti R, Afra J et al (2005) Guidelines for the organization of headache education in Europe: the headache school. Funct Neurol 20:89–93 15966273PubMedGoogle Scholar
- Steiner T, Paemeliere K, Jensen R, Valade D, Savi L, Lainez MLA, Diener HC, Marteletti P, Coutrier EGM (2007) European principles of management of common headache disorders in primary care. J Headache Pain 8:S3–S47 10.1007/s10194-007-0353-8, 18034215View ArticlePubMedGoogle Scholar
- Antonaci F, Valade D, Lanteri-Minet M, Láinez JM, Jensen R, Steiner TJ (2008) Proposals for the organisation of headache services in Europe. European Headache Federation and lifting the burden: the global campaign to reduce the burden of headache worldwide. Intern Emerg Med 3(Suppl 1):S25–S28 10.1007/s11739-008-0189-0, 18792808View ArticlePubMedGoogle Scholar
- World Bank (2009) World development indicators. World Bank, pp 1–409. ISBN: 0-8213-7829-5Google Scholar