The Headache Vault Research Series
U.S. Census ACS 2023 · Burch et al. (2021)
Where are the patients? A national headache disorder population estimate.
We estimate approximately 40.2 million Americans live with migraine — and 10.9 million meet criteria for preventive therapy. For the first time, that estimate is available at the ZIP code level, for all 33,772 ZCTAs, as open data.
Doty A. · July 2026 · Census ACS 2023 + Burch et al. (2021)
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Headache disorder population by congressional district
Click any congressional district to see patient totals.
Explore state-level data including headache centers and programs by state.
Browse state pages →The gap in headache workforce planning
The field knows the shortage is severe. It doesn't have the tools to measure it precisely.
Fewer than 900 UCNS-certified headache specialists serve an estimated 40 million Americans with migraine. That ratio — roughly 1 specialist per 45,000 patients nationally — is cited often. What the field has not produced is the geographic precision needed to act on it: how many patients are in each ZIP code, at what level of clinical complexity, and how far they are from care at the appropriate level.
This dataset provides the patient-side denominator for that calculation. It is the first publicly available ZCTA-level headache disorder prevalence file calibrated to Burch et al. (2021) migraine-specific prevalence rates — not all-headache rates — applied to the full universe of 33,772 ZCTAs. It is provided as open data under CC BY 4.0 for use by researchers, workforce planners, policymakers, and advocates.
A fuller analysis — integrating this population data with provider supply and payer policy data — is planned for later in 2026.
A proposed framework
Matching patients to care. A starting point for discussion.
Population data tells you how many patients there are. It does not tell you what level of care they need. Headache medicine lacks the patient complexity stratification framework that other neurological subspecialties — epilepsy, in particular — have developed to match patients to the appropriate provider level. We are proposing one. It is explicitly a starting point, not a validated instrument.
These complexity levels are proposed for clinical and policy discussion. The criteria are illustrative. We invite input from clinicians, workforce researchers, and policymakers. Send responses to alex@headachevault.com
Level 1 — Specialist center required
Highly refractory; rare diagnoses (NDPH, hemicrania continua); surgical candidacy; inpatient-level needs
UCNS-certified headache center
Criteria: Chronic migraine (≥15 MHD) with ≥3 preventive failures including ≥1 CGRP therapy; or diagnostically uncertain; or inpatient need
Level 2 — Specialist management indicated
Chronic or high-frequency episodic migraine with multiple treatment failures; significant functional disability
UCNS-certified specialist or formal headache program
Criteria: Chronic migraine with ≥2 preventive failures; or ≥8 MHD with MIDAS Grade III–IV and ≥1 CGRP failure
Level 3 — Neurology-level care indicated
Episodic migraine with comorbidities; early chronic; needs preventive initiation; diagnostic clarification needed
Neurology with headache focus; telehealth specialist oversight appropriate
Criteria: 8–14 MHD with disability and ≥1 inadequate preventive trial; or new onset requiring clarification; or medication overuse headache
Level 4 — General neurology or advanced primary care
Episodic migraine with disability; needs treatment optimization; no prior preventive trial
General neurology or advanced headache prescriber in primary care
Criteria: 4–7 MHD with disability (or ≥8 MHD) without prior preventive trial
Level 5 — Primary care appropriate
Well-managed or low-frequency episodic migraine; no specialist referral needed
Primary care with headache-engaged prescribing
Criteria: < 8 MHD without significant disability; or well-controlled; or newly presenting
Indicative national population estimates
| Levels 1–2 — Specialist center | ~400,000 |
| Levels 3–4 — Neurology | ~3.6 million |
| Level 5 — Primary care | ~36.2 million |
Based on Steiner et al. (2021) 90:9:1 international caseload distribution. U.S.-specific distribution unpublished. Treat as illustrative.
Methodology
How the population estimate was built.
Population base:
Census ACS 2023 Table B01001 — sex- and age-specific population data for all 33,772 ZCTAs in the United States.
Prevalence rates:
Burch et al. (2021) calibrated rates — 21% in women, 10.7% in men — with age-band distributions from Burch et al. (2015). Migraine-specific rates, not all-headache.
Preventive-eligible subpopulation:
Buse et al. (2020) AMPP coefficient of 0.273 — patients with moderate-to-high frequency episodic migraine (MFEM 8–14 MHD) and high-frequency episodic migraine with disability (HFEM), normalized within the episodic subpopulation.
Limitation: Prevalence rates are applied uniformly and do not adjust for variation by race, ethnicity, or socioeconomic status. An equity-adjusted analysis is planned.
Open Data
✓ CC BY 4.0Download the dataset.
The ZCTA-level file is freely available under CC BY 4.0. Use, share, and adapt for any purpose with attribution.
headachevault_population_by_zcta_2026.csv
33,772 rows · Columns: zcta, lat, lon, state, pop_total, tier1_total_burden, complexity_level1_2_demand, complexity_level3_4_demand, complexity_level5_demand, mfem_hfem_demand
Download CSV✓ CC BY 4.0Doty A. Headache Disorder Population Estimates by ZCTA.
The Headache Vault; 2026. headachevault.com/research/populationPreprint
Read the full analysis.
The methodology, complexity framework, and population distribution analysis are published as a preprint. Not peer reviewed. Submitted for comment and clinical input.
Headache Disorder Population Estimates and a Proposed Patient Complexity Framework for Workforce Planning
Alex Doty · The Headache Vault · July 2026
Preprint — not peer reviewedAvailable July 27, 2026. DOI pending · Target: SSRN.
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