Abstract
Last year we had a very successful International Headache Congress (IHC) in Rome with approximately 2500 participants and are looking forward to the next 13th IHC in Kyoto in October 2005. The scientific programme of the 12th IHC in Rome was of high quality and the social programme, as always when our Italian colleagues are the hosts, excellent. At this IHC 983 new members joined IHS and I want to take this opportunity both to welcome you and to share with you and all the members of IHS my thoughts on what our Society can, and should, develop further in the future.
IHS has two major objectives: to encourage research in headache disorders and to disseminate knowledge of headache disorders worldwide. In the last 20 years we have seen considerable advances in headache research and especially migraine treatment has advanced with specific drugs for acute attacks. We are now looking forward to breakthroughs in pathophysiological and genetic aspects of headache disorders which most likely will increase the possibility for specific prophylactic treatment. If, however, these advances are not widely available, they cannot benefit our patients. Dissemination of knowledge of headache disorders, their burdens and appropriate remedies is therefore equally important for IHS.
Encouraging research
IHS encourages a high scientific standard of research in several ways. IHS publishes its own prestigious headache journal, Cephalalgia, which in recent years has successfully increased its impact factor to 3.775; Cephalalgia is now rated number 21 among 135 clinical neurological journals. As members of IHS we have an obligation to support our journal, and I encourage you to submit more high quality papers on basic and clinical research. In addition, there should be a natural willingness among members to prioritize acting as referees for the journal. These actions can help to maintain and perhaps increase the high quality of our journal. One major recent event was the publication of the second edition of the International Classification of Headaches Disorders (ICHD-2) available on our website ( http://www.i-h-s.org ) (1). When reading it one quickly becomes aware of how many aspects of headaches disorders still need investigation. The new classification should inspire more research, including a great deal of clinical research, especially in secondary headaches; the clinical picture of a secondary headache disorder, when well characterized and with a definite known lesion or cause, may give clues to general pain mechanisms for head pain.
IHS currently offers, in most years, the following clinical and research fellowships, awarded on the basis of competitive applications (see http://www.i-h-s.org ): Clinical Fellowship in Adult Headache; IHS Pat Humphrey Research Fellowship (Sponsored by GlaxoSmithKline); Childhood and Adolescent Research Fellowship; Therapeutics Research Fellowship (Sponsored by Pfizer). In addition, there are IHS Residents and Trainees Grants to support participation of young scientists at relevant congresses. These fellowships are important for the development of headache research, especially in helping to disseminate scientific skills in both basic and clinical research world-wide. It is my hope that IHS will establish more of these research fellowships with the help of both industrial and other sponsors in the future. I can ensure you that this will remain one of the main priorities of IHS.
The biennial International Headache Congresses (IHCs) have for many years been very successful. To organize the IHC is one of the major tasks of IHS and it is our policy to promote a high scientific standard. In the future, there should be a clearer separation between the scientific and the commercial programmes. We are well aware that the IHC depends on sponsorship from the pharmaceutical industry. IHS is keen to continue the high standards of our professional relationship with our sponsors and we are aware of and determined to avoid the problems that potentially could arise between a medical charity such as IHS and the pharmaceutical industry. As a registered Charity, we have guidance on this from the Charity Commission. In addition, the Ethics Subcommittee of IHS is currently preparing a specific report on sponsorship and the relationship between IHS and the pharmaceutical industry. Further, our rules for conducting IHCs are currently being revised. We have been saddened by incidences of conflicting arrangements interfering with the scientific programme at recent IHCs and shall strive to avoid such incidences occurring in future. Sponsors must agree to adhere to this code of conduct. Failure to do so will not be tolerated again.
But headache researchers need more forums than IHCs for exchanging ideas, and IHS should promote the exchange of opinions among its members. Our website is an obvious platform for this. Other forums could be, as initiated last year, scientific workshops on controversies in headache.
Perhaps the most important means of promoting headache research is to recruit young clinicians and scientists to the headache field. As members of IHS we are all responsible for this. We should start by convincing medical students and junior doctors that headache and its management is an exiting clinical and scientific field. We have available a classification system with diagnostic criteria and we have numerous interesting clinical and basic questions requirings answers.
Disseminating knowledge
In 1997 the IHS Council approved a report of an international Task Force of IHS on organization and delivery of services to headache patients (2). This extensive and very useful report reviewed the problems of headache disorders from an international perspective and described the ideal but still realistic organization of the delivery of services to headache patients both in developed and developing countries. It is still very up to date and full of good ideas, including the headache sufferer's ‘bill of rights’.
While this is the official policy of the IHS, sadly, very little has happened to develop these ideas since the document was published. Members of the IHS will, however, now have the opportunity to remedy this. As a major international headache non-govermental organization (NGO), IHS is collaborating with two other headache NGOs, the European Headache Federation and the World Headache Alliance, to work with the World Health Organization in a global campaign, ‘Reducing the Burden of Headache Worldwide’ (3). This campaign proposes seven steps: i ‘define the problem’; ii ‘build network and collaboration’; iii ‘gather information for better decisions’; iv ‘enhance the research capacity in developed countries’; v ‘persuade others of the problem and its priority’; vi ‘tackle these problems’; and vii ‘prove the case’. This final step will be crucial: in collaboration with WHO's Regional Offices, policy-makers and other key stake holders will meet to plan and implement headache-related health-care services appropriate to local systems and local needs.
In addition to this campaign with WHO, other initiatives of IHS are underway, one of which is the creation of an International Headache Academy. Although in its early stages of development, the aim is to organize major educational congresses on headache in emerging countries to be held in even years alternating with IHC. In the first instance we hope to target Central and North Africa, the Middle East, Central and South America, Asia and Eastern Europe. The input of local expertise on the programme is important because the spectrum of headache disorders and their impact varies from region to region.
The capacity of the members of IHS for teaching on headache disorders is large but there is currently no formal system in IHS for using this expertise. Through the Education Subcommittee of IHS we hope to develop a register of members’ skills and expertise.
IHS should also aim to provide expert help in setting up headache centres. Creating a headache centre in an academic setting is often a useful way to increase the professional status of headache and can help disseminating knowledge on headache. In addition, rare disorders currently not identified and treated can only be diagnosed by adequately trained staff. The contribution of IHS could be to establish contact with members who have the relevant expertise and perhaps also to provide funding for short study visits to an established headache centre.
The website of IHS is under review and we hope to provide more educational information, including reference texts on headache disorders as well as clinical support. This will be especially important for our associate members who cannot afford to buy expensive textbooks but will have access through their membership of IHS.
Finally, IHS has now developed successfully into a large international society. The membership of IHS as a whole should in the future have more influence on the policies of IHS. The society should listen to its members and will provide much more opportunity for members to have their say.