To develop a standardized onboarding process for advanced practice providers (APP) in headache medicine (HM).

There is a significant shortage of healthcare providers with expertise in managing patients with headache disorders. An increasing number of APPs of various backgrounds are entering the field of HM, reducing the gap between certified providers and the migraine population. We provide recommendations for the onboarding and training of APPs in HM practices to address this challenge.

The APP subgroup of the Practice Management Committee (PMC) of the American Headache Society (AHS) developed recommendations after workgroup discussions, review of available literature, and a formal online survey of the AHS membership (conducted in December 2023 and January 2024). Physicians, nurse practitioners, and physician assistant members of the AHS answered questions on current training standards at academic, private, and mixed headache practices.

Recommendations for APP onboarding and training include (1) the designation of a single physician or senior APP supervisor within a practice to guide education, (2)  a formal curriculum comprised of basic science, clinical science, and clinical practice components, (3) a 3-month period of onboarding which includes 2-4 weeks of shadowing without direct patient care responsibilities, (4) supervision and discussion of all clinical duties performed by the APP (5) a minimum of 5 supervised procedures of each type (e.g. trigger point injections, nerve blocks, botulinum toxin administration, etc.) on live patients, (6) structured didactics including lectures and self-study activities, (7) formal grading and documentation of APP competencies, and (8) regular APP feedback to the supervisor.

There currently exists no standard onboarding and training guidelines for APPs in the field of Headache Medicine. We provide recommendations for a more systematic approach to develop qualified providers and enhance their retention in HM practices.