Abstract
Denmark has a more than 50-year history of interest in headache research and management. The first major figure was Dalsgaard-Nielsen, who lead a big neurological department in Copenhagen and had an extensive private practice for headache patients. Another consultant, Axel Klee, wrote a thesis about severe migraine and described the long-term course of many severely affected patients. Professor Erik Skinhøj made the first measurements of regional cerebral blood flow in migraine patients and tutored Jes Olesen, whose thesis was on brain blood flow and the pharmacology of the cerebral circulation with emphasis on the effect on neurotransmitters. This stimulated Jes Olesen to take an interest in migraine, which was likely to be a disorder of neurotransmission. Inspired by the City of London Migraine Clinic, headed by Professor Marcia Wilkinson, Jes Olesen created the Copenhagen Acute Migraine Clinic in 1976. This clinic provided the clinical material for a research program into migraine and other headaches lead by Jes Olesen. The group was interested in several aspects of headache and migraine research, but it was purely research driven with no capacity to care for patients. Despite the fact that the research group was among the world’s most scientifically productive, it was not until 2001 that it became possible, in the socialized medical system of Denmark, to create the Danish Headache Center (DHC) at Glostrup Hospital, now called Rigshospitalet – Glostrup Hospital. The politicians only awarded approximately $250,000 for personnel for the headache centre but, as chairman and professor of the large neurological department, Jes Olesen added additional resources that had already been spent seeing headache patients. Thus, the DHC could start with two full time neurologists, a physiotherapist, a nurse, a psychologist and a couple of secretaries. The centre was immensely popular from day one, and soon had a long waiting list. More important was the fact that many patients came from other parts of Denmark and carried income to the hospital. The whole centre was in fact financed by this income so it was easy to argue for expansion, which would cost the hospital owners (politicians) nothing. In three successive steps, the number of neurologists and other personnel increased dramatically. It was also possible to obtain six beds specifically for headache patients. In parallel with this huge expansion of capacity, space was similarly expanded, but the result is that the DHC today has six different locations in the hospital. Fortunately, it was possible to persuade our politicians to allocated $10 million to the construction of a new building for the exclusive use of the DHC. The exterior of the building already stands, and interior construction will finish at the end of 2017. It contains 2,200 square meters of space over two storeys. The ground floor is for patient management and the top floor, of equal size, is for patient related research and offices. Patient organizations have participated in the design of the new building, which has sound dampening floors, other noise insulation, and pleasant, soft colors. Lights will be adjustable and not too bright, and there are a number of other special features. For link to a movie about the building visit: https://www.rigshospitalet.dk/afdelinger-og-klinikker/neuro/neurologisk-klinik/dansk-hovedpinecenter/om-afdelingen/Sider/dansk-hovedpinecenter-nye-rammer.aspx
The building will be staffed by seven full time neurologists, four nurses, three psychologists, three physiotherapists and six secretaries. In addition, a consultant psychiatrist, a consultant dentist and a social worker are affiliated part time.
Research at DHC has developed continuously. In the beginning, Jes Olesen led it all but several others gradually developed their own groups. Research is now led by three full time professors and two associate professors. Rigmor Jensen took over the leadership of the clinical activities at DHC from Jes Olesen several years ago. She also leads research groups focusing on cluster headache, idiopathic intracranial hypertension, medication overuse headache and epidemiological and socio-economics aspects of headache. Messoud Ashina leads a large group studying the mechanisms of migraine in patients. His group uses different provocation methods, and studies induced changes with several advanced imaging modalities such as MRI, MRA, MR spectroscopy and PET as well as biochemical studies. Lars Bendtsen leads a group on trigeminal neuralgia and also has an interest in medication overuse headache and tension type headache. Henrik Winther Schytz focuses on extra cerebral mechanisms of migraine and other headaches, and is developing a headache diagnostic laboratory. Jes Olesen, despite his 75 years of age, has significant research funding for the next five years. He has partly retired from clinical work but leads, together with Thomas Folkmann Hansen, a large group in migraine genetics. He also leads a large group focusing on the basic mechanisms of migraine using the excellent animal experimental laboratories available at the hospital. Together, these groups have approximately 15 MDs who are PhD students at any one time. The DHC graduates five PhDs and publishes approximately 70 original publications in peer-reviewed journals of medium to high impact every year.
The collection of thesis abstracts presented in this volume of Cephalalgia does not reflect the more recent activity at the DHC. Work is still continuing to improve and expand the DHC: there is an unacceptable two year waiting list for patients with chronic headache. To cope with that, the staff need to be expanded. We also need a national knowledge centre for headache where all Danes and perhaps later also patients from abroad can get advice from a skilled nurse about headache. We need to expand and improve our bed unit, and there are several other future initiatives to be taken. All this will probably come true, because we have many young neurologists who have completed their theses within headache research and who are thus ready to fill the ranks when staff is expanded or elderly consultants retire.