New Investigator and Trainee Telementoring Seminar Series: Be an Innovator in Headache Research by Andrew C. Charles, MD
Summarized by Faye Pedersen
About Dr. Charles
Andrew Charles, MD, is a Professor and Director of the Headache Research and Treatment Program at UCLA. He has held many notable organizational positions including Member of the Board of Directors of the American Headache Society and Board of Trustees of the International Headache Society. He holds Board Certification with the American Board of Psychiatry and Neurology and the Headache Medicine Specialty. He is an author of numerous publications, particularly in the field of Cell Biology and Physiology, a reviewer of multiple well-recognized journals, such as Brain and Nature Cell Biology, and recipient of multiple awards including the Harold G. Wolff Lecture Award in 2012. He is clearly an innovator who effectively bridges the gap between basic science, clinical science, and patient care.
Telementoring Synopsis
Innovation is such a central idea in the NIH culture that a section called “Innovation” is part of the assessment of a grant application. The ability to be an innovator appears to be an elusive trait. However, pioneers in headache research and treatment suggest that innovation is an art that can be learned and honed, particularly in a relatively young field like headache research and treatment.
To be an innovator, first and foremost, one must pay attention to ideas that fail to make sense and be open-minded to radical answers. During her fellowship work with occipital neuralgia, one of his colleagues discovered that C1 may play a role in the migraine pathway. This notion challenges the traditional idea that C1’s lack of a dermatone meant that it did not have sensory functions. Further research into obscure journals found documentation of a large percentage of cadavers carrying sensory functions into the spinal roots. Although in its relative infancy, this finding may help to uncover C1’s contribution to peri-orbital or orbital pain referral in the migraine pathway.
Innovation requires being able to express one’s idea as clearly as possible as the answer to the most basic set of questions. Critique of the idea is readily obtained from colleagues, attendees at meetings, or via list-servers. Judging an idea’s merit may require collaboration with colleagues in and outside the field of neurology.
Innovation demands being brave, exploring, and accepting that the answer may not be immediately available. Despite the absence of a large randomized clinical trial, Memantine is still being used for migraine patients who failed standard first line treatment because it is reasonably tolerated. After acknowledging that patients will be refractory to some medications, the headache community should establish a more careful clinical characterization of the subset where the drugs are effective.
Tantamount to innovation is acquiring support for one’s idea or field, such as headache research. In particular, a researcher should try to pique the interest of colleagues, potential fellows, and students. This can be done by sharing their ideas, the field’s advances, the impact of their work in a disabling disorder like headaches and migraines, and the career and research opportunities available. One can encourage colleagues not even remotely involved in headache research to become interested by sharing how headache questions may apply to their field of study.
There will always be barriers to innovative ideas. In Thomas Kuhn’s The Structure of Scientific Revolutions, scientific development is described as driven by a paradigm which provides the tools and methods for researchers to solve problems. Members who learn the foundations from a paradigm commit to its rules, and thus reject ideas that answer the open questions of the paradigm, but that do not conform to its foundations. Kuhn’s idea that the science that supports the dogma is a ‘mopped up science’ is not entirely accurate, but avoiding work that does not support the current thinking is a flawed methodology, especially in migraine.
For many researchers, funding, especially the quest for an NIH grant, is a challenge, but the innovator recognizes alternate resources: existing registries, clinical trials, pharmaceutical trials, private donors. Many centers have databases focusing on narrow disorders, but to utilize such registries for headache research, headache symptoms must be asked.
The field of headache research is at an interesting point of development. The current paradigm does not account for several important recent developments that challenge the traditional hypotheses of migraine pathways or the efficacy and pathophysiology of certain drugs that are currently used to treat headaches. This means that there are still foundational questions to be asked and answered by innovators who accept the challenge of researching one of the most disabling disorders of the world.
Key Points:
1. Pay attention to ideas that fail to make sense
2. Be able to express an idea clearly
3. Acquire support and critique to test an idea
- Recognize that barriers exist and use creative ways to overcome them
- The headache field is primed for innovation and research
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