Letter From the Editor – Fall 2024

Author(s)Nina Riggins, MD, PhD, FAAN, FAHS

Nina Riggins, MD, PhD, FAAN, FAHS, UCNS Diplomate, highlighted the essential role of advocacy in advancing neurological care, particularly in improving the transition process for pediatric patients with migraine to adult care.

GUEST EDITOR IN CHIEF

Nina Riggins, MD, PhD, FAAN, FAHS, is a board certified Neurologist and UCNS certified Headache Specialist. Riggins completed her Internal Medicine internship at Texas Tech University, and her neurology residency at Penn State Medical Center. Riggins completed her clinical neurophysiology fellowship at the State University of New York, Buffalo and headache medicine fellowship at the University California, San Francisco. Before joining TNC, Riggins directed a headache Center at UC San Diego.

Her work revolves around progressive research and effective treatment for people battling pain and suffering including but not limited to Migraine, Cluster Headache, Hemicrania, Post-traumatic Headaches. Riggins is a Vice Chair of the American Academy of Neurology Headache & Facial pain section and First Contact Program of American Headache Society.

“I believe that this current progress in research, education, and management of neurological diseases would not be possible without advocacy.”

I am honored to be invited to guest-edit this edition of NeurologyLive.

I would like to take this opportunity to celebrate recent achievements in the field of neurology. I believe that this current progress in research, education, and management of neurological diseases would not be possible without advocacy. In addition to my clinical work, I serve the community as vice chair of the BrainPAC Executive Committee of the American Academy of Neurology (AAN) and a Miles for Migraine board member. I graduated from the AAN Palatucci Advocacy Leadership Forum (PALF). My PALF project was “Anticipatory Pediatric to Adult Transition Program for Patients With Headaches.” My patients inspired this work. There is a common gap in care during the transition from pediatricians to adult neurologists.

About 1 in 11 children have migraine. Many kids will have to find adult primary care and an adult neurologist when they reach age 18 years. Current workflow can make it difficult for patients to navigate the medical system at that time. Our kids deserve timely access to quality care.¹

The objectives for this project were:

Optimizing workflow for the transition from pediatricians to adult neurology for headache care
Listing items for timely discussion during clinic visits to prevent gaps in care transition
Improving brain health by providing timely medical care during the transition from pediatricians to adult neurology

The actions we took were:

Interviewing pediatricians and adult headache specialists
Creating recommendations for transition of care in the form of a checklist

I appreciate the participation of AAN and American Headache Society members. I want to express special gratitude to all members of AAN PALF, including my project adviser, Amaal Starling, MD.

Our proposed measurements of success for use of the packet are as follows:

Age of transition is the one identified by pediatricians
How frequently adult neurologists have complete information from referring pediatricians on patients before and after this change in workflow

This checklist is for pediatricians, neurologists, and any clinicians who treat teenagers. We recommend that clinicians address readiness for transitioning from pediatric to adult neurology care once a year, starting at age 15 years.

The checklist is one of the most used, structured health care transition interventions and we hope it will help our patients living with migraine and their families.^2,3

Packet – Checklist PALF AAN

Proposed checklist for annual patient visits with pediatricians, starting at age 15 years:

Anticipated age to transfer care

___________________________________________________________
Headache medicine diagnosis

____________________________________________________________

a) Age of diagnosis

________________________________________________________________
b) Frequency (number of days with headaches in the past 30 days)

____________________________
c) Current and prior treatments

______________________________________________________

Evaluations of headache (MRI brain, eye exam, etc)

___________________________________________

Past medical and surgical history

__________________________________________________________

Family medical history

__________________________________________________________________

Social history

_________________________________________________________________________

Barriers to transitioning care

_____________________________________________________________

Identify whether guardianship or health care proxy documentation is needed. Instruct guardian/conservator to provide a copy to a new adult provider.

_____________________________________________________

Nina Riggins, MD, PhD, FAAN, FAHS, UCNS Diplomate

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