During my years on the Board and as President-elect, it has been a rewarding privilege to work with Professor David Dodick and his team. The initial strategy workshop we had two years ago, in Richmond, provided a fruitful consensus which now serves as the key direction for the society, and will henceforth serve us well. The society has grown to an all-time high in membership, the financials are excellent and the various tasks and committees have been revitalized. So what is left? Where do we take it from here?
Education and teachings: A major task for the International Headache Society (IHS) is to continue its participation in regional conferences, increasing dissemination of headache knowledge to our peers and spreading this in all forms of teaching, not only to our immediate colleagues and specialists, but also to doctors in general practice and to our patients. In this respect the first Global Patient Advocacy Summit (GPAS) was held in Vancouver in September 2017. The importance of this initiative is that with the increasing availability of new digital methods, patients reach out much more today than before and we as clinicians need to get accustomed to this. This is likely to be only the beginning of a new era of two-way communication and the dissemination of knowledge, which is available to patients at all hours and in more varied ways.
Implementation of best treatment: This is something that I see as an important aspect of our role as clinicians. Is it due to the diagnostic difficulties? The Classification Committee has now finalized the ICHD-3 version (to be published in early 2018), which will be a landmark for many years to come. It will serve as the basis for agreement on what type of headache an individual patient suffers from, and this can perhaps be a way to reach consensus on best methods of treatment. Migraine patients should not be treated with medications that are out of date or considered to have a poor outcome or with considerable side effects. Clearly such work needs to be in concert with local experts, but for patients suffering from severe headaches in a cyclic manner, this may be reduced to a large extent with ‘best practice’ being more generally available.
International outreach: Professor Allan Purdy, the Chair of Education and Teachings, has shared his experiences in the medical field and dedication to ensuring that our educational programmes are relevant to clinicians and scientists who deliver care and advance the field. In this aspect I do hope that all previous Presidents and Board members will assist IHS with their vast knowledge and respect worldwide with lectures and advice. It is important to reach out to our members internationally since we are an association of 50 Affiliate Member Societies, to provide guidance in teaching and in promoting leadership in science. We have associations with major groups such as ARCH (Asian Regional Congress on Headache), AHS (American Headache Society), EHF (European Headache Federation), MT (Migraine Trust), and many others. I believe it is important for IHS to continue to foster these contacts and participate as much as possible to show leadership and guidance.
Supporting new leadership: The world is changing and many of us in ‘the old guard’ are still very active, but it is necessary to revitalize our organization with a more balanced leadership in terms not only of age and gender, but also of regional distribution. It is easy to say, but we are only slowly moving in this direction. I hope we will see many new faces on the Board in time to come.
Research: As a society we have over the years supported research in many ways, not only directly with IHS research grants, but also by sending professors to other countries for education, and young colleagues to specialists for short or long stays to learn specifics at leading centres. Maybe it is time to consider other ways to provide leadership in research? (i) Our patient population base is enormous but our field is relatively small. We have over the years been puzzled by this and many thoughts have been advanced. Headache disorders are still characterized on the basis of symptomatology. I think we need stronger facts to be taken more seriously relative to other medical disorders. Today there is an ongoing search for biomarkers, functional MRI to find key regions in the central nervous system (CNS) in different phases of the headache disorders, inter alia. Can we as a society assist in this process? (ii) It is important that the IHS and its researchers stay at the forefront of clinical and scientific work in headache-related matters. We might consider setting up a think-tank to provide new visions in headache science since all on board have been around for quite some time and are experienced in scientific matters. I do share the view with many of our colleagues that it is unlikely that a single factor or mechanism is the cause of all aspects of migraine; we need to broaden our views from CNS, peripheral nervous system (PNS) or a blood vessel disorder. It is likely the understanding of the neurobiology of headache disorders will guide us into finding more specific and targeted therapies; (iii) We clinicians and our patients have a bright future for migraine prophylaxis with the introduction of antibodies towards CGRP and CGRP receptor. These drugs will be introduced to the medication armamentarium within the next two years. We will use the knowledge from the implementation to collect data that may direct us towards further understanding of the primary headache disorders.
The state of the society is very healthy thanks to a long line of dedicated Presidents and Board members over the years, who have been highly committed and visionary. I have the great fortune to continue with much of the same team of key Board members, which gives consistency. Team work for excellence in migraine is my line of action which I will follow while I am President.
