To evaluate the presence of a gender dichotomy in leadership positions and recertification rates within UCNS certified Headache Medicine fellowships.

More male physicians advance in academia compared to their female counterparts. The underlying reasons include bias, professional isolation, imposter phenomenon, and lack of mentorship.

The number of certifications and recertifications within the UCNS Headache Medicine fellowship were analyzed.  

The ratio of men to women in various leadership positions within the UCNS accredited Headache Medicine programs, the American Headache Society (AHS) and all other UCNS subspecialties was analyzed.

645 providers were included in the sample, 276 of whom were female. 100 were new certifications (certified between 2016 and 2018, but not certified between 2006 and 2008); of those, 59% were women. Of 545 specialists who were certified between 2006 and 2008, 455 renewed their certification: 88.9% of women renewed, compared to 79.9% of men (p = .005). 90 headache specialists did not renew after the initial UCNS certification, the majority of which were male physicians (73.3%).

Within Headache Medicine, 66% of fellowship directors are women whereas 39% of headache section department heads are women. Within these programs, 12% of neurology chairs are women. 25% of board members of the AHS are women.  

In contrast, other UCNS subspecialties are less likely to have a female fellowship program director, with women comprising 20% to 50%.

There is a gender disparity amongst leadership positions within neurology subspecialties. Headache Medicine is the only subspecialty where women fellowship directors hold the majority. Furthermore, more female headache specialists are obtaining first time board certifications and recertifications as compared to their male counterparts.  However, even within headache medicine, there are more male program heads, chairs of neurology, and board members. There is need for public awareness, mentorship, and a systematic approach across institutions to bridge this gender gap.