Time’s Up in Headache Medicine: Q&A

Elizabeth Loder, MD, MPH, FAHS, is the chief of the Division of Headache in the Department of Neurology at Brigham and Women’s Hospital in Boston. She’s also a professor of neurology at Harvard Medical School, and a former president of the American Headache Society. When Loder received the 2019 Seymour Solomon Award, she was asked to deliver a lecture during the AHS 61st Annual Scientific Meeting. In her lecture “Time’s Up: Headache Medicine in the #MeToo Era,”  Loder discussed the impact of these movements on headache medicine. She also touched on the importance of continuing the dialog.   

“Sometimes it can be an uncomfortable and difficult topic to discuss,” Loder said. “While we’ve made progress, there also are a lot of things we still have to accomplish.”

Loder spoke with AHS about what still needs to happen and how to keep up the Me Too momentum:

What have Time’s Up and Me Too done for headache medicine?
Time’s Up and the Me Too movement, I think, have done a service in headache medicine. They bring attention to problems that have been there all along. These problems, however, either have not been paid much attention or have been actively ignored or disregarded. It’s hard to ignore the number of women tweeting “#MeToo” and the people joining the Time’s Up movement in health care. The momentum that’s been generated has made it more acceptable to examine, discuss and think about solutions for these problems.

What are the things that have to be accomplished? What changes need to happen?
I think we have to think broadly beyond just general sex discrimination, sexual harassment, micro-inequities, and structural barriers that prevent women from achieving their full potential in the workforce. We have to think about how these things relate specifically to headache medicine. 

It’s also important not to lose sight of how these things indirectly affect our patients. Migraine and cluster headache are highly gendered diseases. A lot of the disorders we treat are bound up with our perceptions of women. The stigma associated with migraine is, in part, related to the fact that it’s perceived as a women’s illness. This harms our female patients, as well as our perceptions of the headache field and its practitioners—both male and female.

What opportunity do you see for AHS to set an example? Where do we start?
The American Headache Society has done a wonderful job of making a lot of improvements. The leadership is more diverse, and there are more women than ever in positions of leadership within the society. I am a past president, and our current president is a woman. We have women in other leadership positions, but the sex ratio does not fully reflect what we see in the membership. It’s still the case that the speaker panel and the faculty for [the 61st Annual Scientific Meeting] is about one-third women, and that’s progress. But 60% of physicians under the age of 35 are females, so there’s still a ways to go.

What sort of gender bias have you faced throughout your career?
I think anyone my age can look back and think of lots of problems that we had that were at least in part related to being women. I trained at a time when there were no policies about maternity leave; if people got pregnant when they were in residency, there was no support for things like breastfeeding. If you did come back to work, there was very little recognition of the fact that somebody might have childcare responsibilities and not be able to attend meetings in the evening. It was difficult for women—even if they participated as investigators in clinical trials—to secure authorship on the resulting papers. There were a lot of situations like that.

How do you advocate for women at the institutional level?
Advocating for women at the institutional level can be more difficult. Academic institutions have their own set of problems, just like private practice has. One way to advocate for women is to ensure that one’s own institution reviews salaries and has explicit metrics for measuring performance and recognizing women’s contributions. This often includes things like unreimbursed committee work. I also think it’s important for institutions to have explicit policies on complaints of sexual harassment or other problems women face. 

Again, this helps men as well as women. It makes sure that the workplace is friendly for people who may have young children or other responsibilities.

If you had to prioritize what issues you want to bring to the table and how to solve those problems, what’s your top priority?
I think the first step in solving the problem is making people recognize that it exists. One thing that is often unspoken is a feeling that more opportunity for women or other underrepresented groups means less opportunity for others. In particular, men. It’s not just women who have suffered from a lack of mentorship or lack of opportunity. There are many men who also have not had the opportunity to express their full potential. But I think that more opportunities for women don’t have to come at the expense of men.

Elizabeth Loder is a member of the American Headache Society. AHS is a professional society for doctors and other health care workers specializing in studying and treating headache and migraine. The Society’s objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders. It also aims to share and advance the work of its members. Learn more about the American Headache Society’s work and find out how you can become a member today.