Abstract
Attending the International Headache Society meetings gives me the opportunity to learn where knowledge ends – a critical step in determining which question to ask next
My name is Rami Burstein, I am a headache researcher whose career path was shaped and defined by the International Headache Society (IHS) – an organization I was fortunate enough to join at a very early stage of my career. Prior to joining the IHS, I could not see past the animal experiments I was conducting, and badly misjudged the fundamental weaknesses of adapting the bench-to-bedside approach alone. By joining the IHS, I got the opportunity to listen to countless lectures by clinicians and scientists who knew things I did not know at the time. While listening to those who were writing the principles of headache medicine then, I learned two things that years later seemed critical in defining my career. The first was ‘where knowledge ends’. The ability to define correctly where knowledge ended (and speculations naturally started), allowed me to prioritize the questions I was trying to answer. These questions were ones that I, as well as many of my colleagues, thought were important to answer in order to advance our understanding of headache pathophysiology and treatment. Equally important, I was trying to answer questions to which I knew there were no answers. The second was the power of the ‘reverse-translational’ approach. Adhering to this approach – where knowledge gained in clinical observations is used to define hypothesis, aims and experiments in animals (i.e., bedside-to bench) – had helped me query things that over time led to a better understanding and clearer answers to questions such as: why a migraine headache throbs? why is the scalp tender and the skin hypersensitive to touch? how can a light causes the headache to be more painful? and how can some headaches begins 30–60 minutes after aura and others, simultaneously with the aura?
Over the years, I also learned the power of using the bedside-to-bench and bench-to-bedside approaches concomitantly, an approach that allowed me (a) to use clinical observations to define questions we can ethically answer in patients and questions we must try to answer in animals as we cannot test in patients, and (b) to determine if observations and findings made in animals could be observed in patients, as in the absence of a clinical correlate we are bound to use irrelevant animal models. Using this combined approach, we define novel anatomical and physiological ballparks for conceptualizing how migraine headache alters sensory, autonomic, cognitive, and affective functions during and in between migraine attacks.
On the road to universal access to quality care
My name is Tina Charway-Felli. I am a Co-opted Trustee on the Board of the International Headache Society (IHS), member of the IHS education committee and current President of the African Academy of Neurology (AFAN). It is through my activities with the African Academy of Neurology that I have become involved in many of the international specialty organisations and specifically the IHS.
I am one of seven, soon to be ten, trained practicing neurologists in Ghana, serving a population of over thirty million. I work in a military hospital in the capital of Ghana, Accra.
I am predominantly a clinician, and it is through my daily practice that I see how important awareness, advocacy and education (both of the general public and healthcare practitioners) are to ensuring access to appropriate care for those living with neurological disease, and specifically headache. All too often in my practice I see those who have suffered in silence with their headache for years and have received either no, or substandard, management.
Together with the IHS-Global Patient Advocacy Campaign (IHS-GPAC) and the World Federation of Neurology (WFN), AFAN has been instrumental in in creating a series of programmes entitled “Education in Headache to Healthcare Providers in Africa” (EHHPA), which is running its second year of activities. This programme is targeted towards increasing awareness and recognition of different headache types in healthcare providers of different grades – from primary healthcare providers up to neurology and headache specialists. To do this, it is also imperative that we document accurately the burden of headache in our communities.
I am passionate about all manner of programmes that will serve to improve access to care and inch us closer to establishing a world where all aspects of health, and particularly brain health, are catered for irrespective of geographical location and economic status.