Within my demi generation of neurologists, migraine was largely an afterthought, a condition implicitly (or explicitly) “psychosomatic” at which we might throw a bit of therapeutic this n' that: a beta blocker here, an oral ergotamine there and – for the more adventuresome – the occasional infusion of dihydroergotamine. Typical of the times, I received virtually no formal education regarding the diagnosis and management of the primary headache disorders during medical school and residency training.
Having developed an interest in what now is characterized as migrainous infarction, about 20 years ago I began seeing an ever-increasing number of migraine patients in my clinics which previously had been devoted primarily to cerebrovascular disease. At about that same time, 2 other factors combined to draw me yet further into the “shadow world” of headache medicine: I attended my first American Association for the Study of Headache (AASH) educational conference at the Camelback Resort in Scottsdale, and by serendipity I became involved in the clinical research which led to the emergence of injectable sumatriptan as a self-administered therapy for acute migraine of moderate to severe intensity. From that point on, my professional life has become ever more consumed by the effort to understand headache and to treat its various clinical permutations more effectively.
My own professional metamorphosis is not so unusual. A number of others familiar to this journal's readership similarly cut their investigative teeth in the field of cerebrovascular disease and subsequently moved on: Drs. KMA Welch, Nabih Ramadan, Sheena Aurora, David Gordon, and others. Preceding us were those pioneers who forged the first paths into the terra incognita of headache (Drs. John Graham, Sy Solomon, Seymour Diamond, Donald Dalessio, John Edmeads, and Neil Raskin among them), and joining us were inherently skilled scientists who chose to apply their talents to this “new” subspecialty area (Drs. Peter Goadsby, Michael Moscowitz, Andrew Charles, Michael Cutrer, Rami Burstein, and a host of others), along with a veritable brigade of clinician scientists bent upon applying the knowledge obtained in the laboratory to the practice of headache medicine.
And so headache emerged from the closet. In this issue, we seek to present to our readers highlights from the compelling saga of headache's ascent toward acceptance as a “legitimate” subspecialty and to celebrate the progress made over the past half-century. Much remains to be accomplished, but it is largely from the momentum that was built over the past 50 years – and the efforts of those many individuals who participated in supplying that momentum – which will enable us and those who follow to advance the field yet further over the 50 years to come.
John F. Rothrock, MD
Editor in Chief