NIH Peer Review, Research Funding, and the Future of Headache Medicine
NIH sought public comment on a proposed change to how it reports peer review outcomes. AHDA submitted comments on behalf of the migraine and headache disorders community.
The future of headache medicine depends on research; research that helps us understand how headache disorders develop, improve diagnosis, test new treatments, and make care more effective for people with different needs. The National Institutes of Health (NIH) plays a central role in supporting that work and the researchers who will carry it forward.
NIH asked for public input on a proposal to change how grant review results are reported. Under the proposal, applications would be placed in one of three categories: “most competitive,” “competitive,” or “not discussed.” NIH would continue calculating final overall impact scores to assign these categories, but would no longer report those scores or percentiles to applicants, their institutions, NIH program staff, leadership, or relevant advisory councils. Written critiques and criterion or factor scores would remain available. You can read the NIH announcement for details.
AHDA recognizes that peer review scores are imperfect and should not determine funding decisions on their own. But a broad category also has limits. An application near the top of a category and one near the bottom could receive the same designation, while proposals with nearly identical assessments could fall on opposite sides of a category boundary. Neither a score nor a category alone predicts whether a proposal will be funded or captures all of its strengths and weaknesses. Applicants and decision-makers need the full review record.
In its comments, AHDA urges NIH to continue reporting final overall impact scores and percentiles alongside reviewers’ critiques. If NIH moves forward with categories, we recommend testing them while continuing to report scores, then publicly assessing how the change affects applicants’ understanding, resubmission decisions, and funding outcomes. We also urge NIH to ensure that proposals on migraine and other headache disorders receive review from experts with relevant knowledge of headache research, as well as the methodological expertise needed to assess each application.
This is especially important as NIH reshapes its funding opportunities. NIH has described a shift toward fewer, broader opportunities and fewer highly specialized announcements, while saying that fewer opportunities does not mean fewer funded applications. Broad opportunities can support investigator-led ideas. Targeted announcements can also signal that NIH wants proposals in areas with significant scientific gaps or public health needs. For under-researched conditions, including headache disorders, AHDA believes both approaches matter. NIH should use targeted announcements when needed to encourage proposals in areas where research investment does not reflect disease burden, alongside sustained investment across relevant Institutes, Centers, and Offices.
The need is substantial. The World Health Organization ranked migraine third among neurological diseases by age-standardized disability-adjusted life years in 2021. NIH’s FY2025 estimates list $43 million in its Migraine category and $54 million in its Headaches category. NIH cautions that these figures are estimates, that categories can overlap, and that it does not budget by category. They are not a complete accounting of every NIH-supported project relevant to headache disorders, but they offer a window into the current research portfolio.
Research funding is an investment in the future of care. It gives scientists the opportunity to ask questions that may not yet have clear answers, supports the development of new investigators, and builds the evidence base clinicians need to improve treatment. Sustained NIH support can help ensure that headache research keeps pace with the enormous burden of these disorders and the needs of the people living with them.
NIH’s decisions about peer review and research priorities shape which questions scientists can pursue and how new investigators enter the field. AHDA will continue to advocate for meaningful feedback for applicants, relevant expertise in the review of headache research, and sustained investment in the research needed to advance care for people with migraine and other headache disorders.