Abstract
Making the activity of the International Headache Society more ubiquitous in Asia
After graduating from the medical school, the first clinical study that I was engaged in was about autonomic dysfunctions in patients with migraine and cluster headache. In retrospect, this was my first encounter with the headache research world. Although I saw many neurological disease patients as a young neurologist, I was particularly interested in the complex and multifaceted clinical manifestations of migraine, reflecting cortical and subcortical abnormalities in conjunction with trigeminovascular and autonomic activation. I believe that recent progress in migraine therapy, such as the introduction of CGRP-based medical treatment and neuromodulation, will not only benefit patients but also contribute to elucidation of enigmatic migraine pathophysiology. Currently, I am doing translational migraine research with a view to discovering novel therapeutic targets.
Also, I have been involved in various activities of the Japanese Headache Society (JHS). Thanks to the initiatives of Professors Sakai and Suzuki, the JHS has been steadily growing in recent years. In 2013, the JHS invited the Headache Master School to Tokyo, where many physicians from the Asia-Pacific region learned about the latest headache medicine and actively interacted with world-leading headache experts, some of whom are current IHS Board members . I was totally fascinated by the expertise of each speaker, and this experience made me realise the importance of education. Unfortunately, in many Asian countries, migraine and other primary headache disorders are undertreated, and the awareness of secondary headache disorders is insufficient. As a Board member of IHS, I am determined to devote myself to improving the current situation of headache medicine in Asia. For this purpose, it is essential for the national societies in the Asia-Pacific region to unite and promote the Asian Regional Conference for Headache (ARCH) initiative under the auspices of IHS.
Department of Neurology, Keio University School of Medicine, Tokyo, Japan
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Walking the boardwalk of headache education!
As I returned to the Board last year as the Education Chair of IHS, I became more excited about the future of headache education in the world. After over 40 years in neurology, I now see that it is more important than ever to teach our colleagues and ourselves, as well as all who are interested in headache, about what we know – which is quite a lot – and about what we don’t know, which is really fathomless.
When I was a young neurologist in private practice, I found that the headache patients were most interesting and appreciative of anything done to help them understand and cope with many common and unique headache disorders. I clearly remember saying to myself late one afternoon, after seeing many patients, that if there was one headache disorder/disease that I would love to learn more about, it would be migraine. I can now confidently say migraine still represents for me the most unique of neurological disorders, and each time I see a patient with migraine I learn something new about how the brain works. Of course, other headache disorders can hold great interest for neurological consultants and are a source of great interest and concern for our patients. They all benefit from the best of headache education, I have found over time.
So where we are headed in the future remains uncertain when it comes to our understanding of headache disorders and headache education. I believe, however, that history has given us some direction. For centuries, migraine in particular has held great clinical and scientific interest for the top neurological minds in the world. Major advances were made in diagnoses, but less was done for investigation and treatment. However, in the late 20th century, migraine research in particular took off and we have now seen fundamental strides in diagnosis by way of a sophisticated and evolving classification; basic research in pathogenesis from remarkable laboratory work in basic neurosciences, clinical studies, and significant strides in neuroimaging, including the structure and function of the brain during the entire attack processes. Advances in treatment with the triptans, over 25 years ago, have sparked worldwide interest in migraine therapy, and now even more remarkable agents and therapies are about to enter more advanced clinical trials.
So where does this leave us? It leaves us with a massive amount of knowledge to continue to explore myriad possibilities regarding diagnosis, treatment and management. The data available on headache disorders grows daily and appears to be endless. Nevertheless, there still remains a need and multiple opportunities to teach others about where migraine and other headache disorders fit into the broader field of neurology. The secondary headache disorders can now be parsed more accurately diagnostically and managed better, but of course there is more to do.
In Canada, almost 20 years ago, my colleagues Werner Becker, Michele Aube and I started a national residents course for senior neurology residents, held annually at the Montreal Neurological Institute at McGill University. We held it there because of the historical significance of that institution in the world of neurology and neurosurgery. Peter Goadsby and Fred Sheftell were our first visiting faculty, and later David Dodick and many others came each fall to join us for a three-day didactic and interactive case-based course. Our stated goal was to present and teach about headache disorders, but our real goal was to change the attitudes of neurologists in Canada regarding headache. We have succeeded in our goals, I believe, and now there are more headache specialists with advanced training than before in Canada and current neurologists who came to our course, but went into other areas of neurological practice or study, are now taking more of an interest in headache.
I have travelled many places in the world to learn about headache and help to spread the word about this most interesting field of study and clinical practice. What a wonderful opportunity to meet and work with our top clinicians and researchers in the field. I have never considered myself a ‘headache specialist’, but always a ‘neurologist with a special interest in migraine and other headache disorders’. Teach and be taught is an old aphorism in life and teaching. So helping to lead and direct headache education for our society is an honour and a pleasure for me. Please enjoy and support the multitude of learning opportunities offer by IHS each year. You, the members, are the reason we on the Board work hard to make our educational activities meaningful to you and hopefully helpful for your patients.
Department of Medicine (Neurology), Dalhousie University, Halifax, Nova Scotia, Canada
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