November 2022 Society Spotlight

I never intended to become a migraine specialist, let alone specialising in hormonal aspects of migraine, but curiosity about a condition that so little was known about, yet resulted in such significant disability, became an obsession as I wanted to find answers to the problems.

I completed my medical training at St Bartholomew’s Hospital, London in 1986. Following an exhausting year of 1 in 2 house jobs (which fortunately no longer exist), I took what was meant to be a short ‘break’ in my training, taking up a research post at the City of London Migraine Clinic in central London. Like most healthcare professionals of that time, I had very little training about headache as a medical student. It did not take me long to appreciate that this was an area of medicine that had a huge impact on people’s lives but was rarely taken seriously and very under-researched.

The City of London Migraine Clinic was unique, as were its founders, Dr. Marcia Wilkinson and Dr. Nat Blau. They opened the clinic in 1979 in an old townhouse built in 1788 that was situated in a historic central London square, close to St Bartholomew’s Hospital. Outpatient clinics were held in the mornings while the afternoons were dedicated to research. London workers experiencing an acute attack of migraine or cluster headache could also attend the clinic for treatment at any time during the working day.

Our research covered a broad spectrum of topics, including ice-cream headache (a particularly fun but very messy piece of research), analgesic overuse and other clinical aspects of headache, and drug trials for pharmaceutical companies. It was notable to me that over 80% of people attending the clinic were women, many of whom blamed their menstrual periods as causing their attacks, so I became particularly interested in how women’s hormones affected migraine. I realised that following a standard training path in neurology would not provide me with the training I needed to understand this connection. So, I took up additional training and posts in menopause and contraception to complement my clinical and research work in headache. I have been privileged to have had the support and learn from top clinicians and researchers from all over the world, as well learning from the numerous patients I have seen over the years.

Attending conferences and keeping up with the research published in the journals continues to contribute to my learning. Judging from the collection of Headache journals on my bookcase, I must have joined the American Headache Society in 1990 (at that time known as the American Society for the Study of Headache) at a time when there weren’t many ‘foreign’ members. Over the years have attended many of the Society’s meetings. During my time as General Secretary of the International Headache Society, we worked closely with AHS, and I have fond memories of several memorable and enjoyable planning meetings.

I have been incredibly fortunate to have worked in this field through an era of historic change in management and in the understanding of migraine pathophysiology.  In the late 1980s, the standard treatment for patients attending the City of London Migraine Clinic with an acute attack of migraine was an antinauseant, 900mg aspirin, and a sweet cup of tea. Around a third of patients needed the addition of ergotamine. Shortly after starting clinical trials with GR43175 – subsequently sumatriptan – it became apparent that this something that could really change the lives of people with migraine. Such was the revolution in symptomatic treatment that our acute treatment service became redundant as GPs could at last prescribe an effective treatment specific to migraine. Recent years have seen a second revolution with research and development into the CGRP antagonists for prophylaxis, and no doubt there will be more innovations to come.

Despite these remarkable achievements, research into the specific needs of women with migraine and the effect of hormone changes throughout women’s lives has been limited. It is encouraging to see that these issues have begun to generate wider interest. I continue to grow this cause in both clinical research and clinical practice, the latter providing a rich source of unanswered research questions. I am also passionate about educating both headache specialists and women’s health specialists about the effect of female sex hormones on migraine in women, with the aim of increasing the recognition of, and need for, cross specialisation in training in the generations of headache specialists that follow.

I am honored to receive the 2022 Women’s Health Science Award and encourage everyone working in migraine to help expand our understanding of this fascinating but neglected aspect of headache medicine. Thank you!

E. Anne MacGregor, MBBS, MSc, MD