Abstract
In the last few years we have seen significant progress in the understanding of migraine pathophysiology and in potential new treatments. Better understanding of the disorder has not always led directly to targeted therapies, although for the first time we are now seeing new therapies truly targeted to the basic pathological mechanisms of migraine. In many cases, new treatments have been found by serendipity and this has directly led back to research directed towards explaining these observations.
The Witness Seminar series, as devised by the Wellcome Trust’s History of Twentieth Century Medicine Group since 1993, has now covered more than 50 subjects on a wide array of biomedical topics, bringing together clinicians, scientists, representatives of patient organisations and medical historians to hear them recall and discuss their recollections of the major developments and of the personalities of those individuals who had greatest influence in shaping (both positively and negatively) the evolution of the subject. Each transcript welcomes historical truth and has not been ashamed to paint what some might perceive as negative pictures of individuals, the medical profession (not least, that of UK neurology) and the wider social and political climates of these decades.
I felt privileged reading this book to have been allowed such a frank insight into the recent medical history of migraine and headache and the Wellcome Trust are to be congratulated in putting together such an excellent seminar. We are lucky to have a number of clinicians in the field who show a passion for the history of medicine and the success of this seminar and transcript is, in my view, largely down to the excellent historical knowledge and Chairmanship of Mark Weatherall.
Giles Elrington in his eloquent introduction comments that: ‘those who aspire to stand on the shoulders of giants should try to do so without causing too many headaches’. It is clear when reading about the greatest individuals and developments in headache medicine that we all potentially have the opportunity to impact the future for our patients, for better or worse. Themes that run through the Seminar transcript are ‘good’ science and the need to accurately define the conditions we treat. The Seminar discusses in detail the way in which some of the greatest developments have occurred, specifically focusing on those related to the theories of pathogenesis (e.g. the science and characters behind the vascular vs. neuronal concepts), the initial recognition of a classification of headache and its evolution and the development of drugs specifically considered to target the mechanisms of generation of migraine, most notably the development of triptans.
The shape of the Seminar has clearly been influenced by the particular group of invited discussants and I feel that a different group of individuals might have painted a different view of events and the most important characters. One cannot help wondering how the discussion might have taken a different route and reached different conclusions if certain individuals had or had not been present. Having read the book cover to cover while on holiday on a beautiful Greek island, I was left with a similar feeling to leaving that island, the realisation that I had only scratched the surface of what was truly there and the feeling already of a need to return one day and the realisation of so many other places yet not visited. I do hope that the Wellcome Trust continues to evolve this series and one day has cause to return to migraine and allied conditions.
One of the most fascinating aspects of the conversation, which could only have arisen from this type of forum is the question as to why migraine has not always been and is still often not perceived as an important problem that requires research development (and obviously funding) despite being such a common and disabling condition. We must ensure that future approaches to the condition and the development of optimal treatment will allow more people to manage their lives effectively within its huge shadow.
I would thoroughly recommend this book to anyone who has a personal or professional interest in migraine, whether they be doctors, other health care professionals, scientists or indeed sufferers. Whether interested in science, human nature, gossip or just how humans look at the mysteries of human nature and the human body, one cannot fail to appreciate how easy it is to read and be stimulated by this excellently transcripted Seminar on what has to be one of the most interesting and important evolving areas of medical and neurological history.