October 2021 Society Spotlight

The Best is Yet to Come

Hello to my extended AHS family. My name is Richard Lipton and I have been involved with AHS for over 30 years. It was my honor and privilege to serve as AHS president from 2000-2002, an astonishing 20 years ago. As my presidency was winding down, Steve Silberstein told me that I had peaked too early. I laughed and told him that I thought the best is yet to come. Since then, I have attended board meetings as an advisor, taught in Scottsdale, presented at our scientific meetings, and worked on a variety of educational initiatives including the Chronic Migraine Education Program (CMEP) and the Next Generation Migraine Therapies Program.  At the upcoming 2021 Scottsdale Headache Symposium, I will participate in a debate on the relationship between migraine and sleep addressing the question of directionality of effect. Does migraine disrupt sleep, does disrupted sleep increase the frequency of migraine or both?

As Director of the Montefiore Headache Center, I have mentored many clinicians and researchers. I am delighted that so many of them have gone on to distinguished careers. Many direct headache clinical programs of their own. Others led research groups, and many are training the next generation of headache clinicians and scientists. Some of these individuals have also assumed leadership positions within AHS. Because of their efforts, the best is yet to come.

Though I love patient care and teaching, my true passion is for clinical research. I conducted a series of cross-sectional and longitudinal epidemiologic studies that provide serial report cards on medical care for migraine in the US. From these studies, conducted with many remarkable collaborators (special thanks to Buzz Stewart, Michael Reed, Marcelo Bigal and Dawn Buse, among others), we learned that most people with migraine who seek medical care do so in primary care settings. This finding motivated many of us to engage with primary care providers, as a key target for improving migraine outcomes. These studies also revealed that even in the general population migraine is often severely disabling; this observation led to a focus on migraine disability as a target for treatment. We also observed that diagnostic rates for people with migraine have climbed from 39% in 1989 to 60% in 2019. This 54% increase in diagnosis demonstrates remarkable progress, but we still have a long way to go. Finally, we observed that in the population, migraine often progresses in the setting of multiple remediable risk factors.  Increasingly, we are thinking of chronic migraine as a sometimes-preventable disease. Because of initiatives of AHS, the American Migraine Foundation (AMF), CHAMP and others, the best is yet to come.

I worked with many amazing colleagues, on the development of measures intended to facilitate research and improve health care delivery for migraine, particularly in primary care settings. Those measures include the AMS/AMPP diagnostic module, two diagnostic screening tools (ID-Migraine and ID Chronic Migraine), multiple symptom assessment measures (the Migraine Symptom Severity Score, the Allodynia Symptom Check List), disability/burden measures (MIDAS, the Migraine Interictal Burden Scale, AIM-D), and a treatment optimization measure (mTOQ). These measures have not yet found widespread use in primary care as I hoped, but they have found a place in research and in specialty care. I am currently working on an FDA-funded project, co-led by RJ Wirth, to develop patient-centered outcome measures for clinical trials in migraine. Through efforts to better measure the burden of migraine and the benefits of treatment and nascent efforts to develop policy recommendations for migraine screening, the best is yet to come.

To my friends and colleagues in the AHS, I view all of you as my brothers and sisters in arms. Our battle is against a disease, long stigmatized, often misunderstood and sometimes underdiagnosed and mistreated. Looking back on my 30-year affiliation with AHS, it is astonishing how much progress we have made. Migraine is now recognized as the world’s second most disabling disorder. There is an explosion of new treatments (pharmacologic, lifestyle and behavioral as well as devices), new treatment strategies, and new efforts to close the gap between treatment available and treatment delivered. Because of all of you, the best is yet to come.

Richard B. Lipton, MD, FAHS

richard.lipton@einsteinmed.org