Current Series: Chronic Migraine: New Paradigms in Management

Stephen Silberstein, MD: Closing remarks. Dr. Ailani.

Jessica Ailani, MD: Well, thank you. I think that at the end of this topic discussion, it’s important to remember that migraine is not a difficult disease to diagnose, that many of our patients in a neurological practice have migraine. We should have these conversations with them. It’s an extremely exciting time, as we have so many options available—oral, injectable, injections in the office, injections at home—and that really presents a wonderful opportunity to start having conversations with your patients about treatment options.

Stephen Silberstein, MD: Peter…

Peter Goadsby, MBBS: It’s an incredibly exciting time. I mean, migraines and disorder of the brain—neurologists look after brain disorders. Migraine is the most common neurological cause of disability on the planet. The second-most-common cause is loss due to disability of any condition on the planet. And the opportunity to make people who’ve just had their lives ruined, to turn it around and make people better, that’s what I got into medicine for. It’s beyond an exciting time to be a neurologist.

Stephen Silberstein, MD: Stu...​​

Stewart Tepper, MD: It’s a watershed moment. I’ve been a headache doctor since the Ronald Regan administration, and this is the most exciting time, not just with monoclonal antibodies but with a variety of targets, with acute treatment, with neuromodulation. There are so many options for our patients that it is so exciting for me to be able to reach out to patients and say we’re not going to stop till we help. This is really a very hopeful time.

Stephen Silberstein, MD: David...

David Dodick, MD: Well, it’s hard to build on that, but I would say, yes, of course, the fact that we can change lives in a way that we weren’t able to before is remarkable. But above and even beyond that, this is going to legitimize the biology of an illness that for a long period of time has been stigmatized as a psychosomatic illness of neurotic people. And when you can target a receptor or a peptide that is intimately involved in the pathogenesis of a disease, you’ve figured something out in a very detailed way about the biology, and you can target that with a biologic, with a monoclonal antibody. That’s remarkable. So it legitimizes the biology of this illness, full stop.

I think it also is going to inspire new people to come in. Because young doctors go into medicine to help people. And when they see all that we can do now, when they wander through my clinic and they see the litany of things that we can do for these people, it’s a challenge to find someone we can’t actually help. And so it’s going to inspire, and I’ve seen it already, new people coming into this field because we need more doctors dedicated to this space and to these patients. That’s number 2. And then number 3, just as the triptan era taught us a lot about serotonin, receptor pharmacology, and now we’ve engineered molecules that come out that are triptan like but avoid the vasoconstrictor part of it, the science over the next 10 years as we figure out where these work, how these work, is going to open up new vistas, I think, and new targets that are going to be even better for patients.

So as my colleagues have said, there’s never been a more exciting time to be in this field. And I’m just glad I got to see it before I’m done.

Stephen Silberstein, MD: I have 1 last comment. We often have students or other doctors coming in and spending time with us. But a patient can come around for a while, one I’ve been seeing for 20 years comes in but doing well. They come in once a year, so I tell the patient, “Tell my guest what you were like.” And they say, “When I came here originally, I had headaches every day, I had no life, and now I’ve got my life back.”

It’s almost like taking care of headache patients is like resurrecting the dead. That’s what we do. We bring people back to life. Thank you.