James W. Lance, MD

James W. Lance MD, Professor Emeritus of Neurology in Sydney, Australia, died on 20 February 2019, age 92.

The Sydney Morning Herald in reporting the recent passing of James Waldo Lance described him as the neurologist who put migraine on the map; certainly, a good start to honor one with brobdingnagian influence on headache medicine.

Born in Wollongong in 1926, educated in Sydney at school and university, he took postgraduate studies in London at Queen Square with Sir Francis Walshe, and then at Massachusetts General Hospital with Raymond D. Adams. He was the first physician appointed as a neurologist in Australia and the first professor of neurology.

Jim was the epitome of the clinician‐scientist well before the term was invented. He had done fundamental bench physiology on the corticospinal tracts that naturally led him to be interested in movement disorders. His 1980 Robert Wartenberg Lecture on the control of muscle tone, reflexes and movement should probably be read by any neurology trainee who is curious about what they are doing when they use a reflex hammer. His description of post‐hypoxic myoclonus with Adams ringing as true today as when it was written and easily justifying the eponym Lance‐Adams Syndrome. His work on simple formed hallucinations or the red ear syndrome, illustrating the breadth of his interests. The latter beginning with 3 cases presented at the Australian Association of Neurologists, where he had asked in his presentation for colleagues to “lend him their red ears”; the final report had 12 cases, his request not falling on deaf ears.

Yet it is for headache that many will remember Jim Lance. He was invited in March 1980 by Federigo Sicuteri in Florence to join 20 other international researchers who had expressed the wish to found an international scientific society dedicated to headache. The International Headache Society (IHS) was thus founded in 1982. Jim was the 4th President of the IHS from 1987 to 1989, chairing the 4th International Headache Congress in 1989 in Sydney. In 2015, Jim received the IHS Special Recognition Award for his important contributions to headache medicine. He was a recipient of the Harold G. Wolff and the John Graham Senior Clinician Awards from the American Headache Society.

Jim had a keen interest in both clinical headache medicine and a strong basic science involvement. He was a master clinician: both an astute and detailed history‐taker, and as elegant at physical examination as one would ever hope to see. He was member of the Headache Classification Committee for the first and second editions of the International Classification of Headache Disorders (ICHD). Under his presidency, the first edition of ICHD was published in 1988. He described several headache syndromes and invented new terms; for example, he was the first to describe headache associated with sexual activity as a distinct headache disorder. He coined the term Harlequin Syndrome, characteristically taking advantage of one of his greatest loves, his children and one of their toys, and with his razor-sharp thinking pursued its pathophysiology. He published over 200 papers and many more chapters and abstracts, mostly in an era without a word processor. He wrote books, the classical A Physiological Approach to Clinical Neurology with his colleague Jim McLeod, and the very accessible Mechanism and Management of Headache. A renaissance man, he wrote The Golden Trout for his 5 children, 19 grandchildren and 1 great grandchild and the many more to come, reflecting well his irenic influence in any setting.

Jim was at the forefront of headache research for much of his career. The meticulous description of 500 cases, clinical trial work from methysergide to sumatriptan, and the clinical biochemistry of serotonin in migraine, marked out a systematic approach to the clinical problem. Jim bought the seriousness of bench physiology and a respectability that was not terribly common for matters of headache in the 1960s.

Jim was widely respected internationally and certainly no less at home in Australia. He was Commander of the Order of the British Empire (CBE) and Officer of the Order of Australia (AO). Jim was, as his daughter described him at his memorial service, unfailingly polite. This was applied to all he met, in all circles, at all times. It is said one mark of a person is how they behave to those who can do them no advantage; by this mark Jim Lance passed muster at the highest level. He was always considerate and thoughtful even when faced with braggadocious assertions. Politely suggesting further reading or the possibility of another interpretation. He had a wonderful sense of humor, especially quick‐witted, his quips are now legend. When the term short‐lasting neuralgiform headache attacks with conjunctival injection and tearing was first mooted, it was he who remarked “the names get longer as the attacks get shorter.”

Jim and, as he described her – his wonderful love – Judy, were most gracious hosts. During his career, he would yearly host a party for the department, research staff, and visitors. Good cheer, his stories – he could riff on most anything; his children helping and Judy at the helm, a view of Sydney Harbor, and a glimpse of work‐life balance at its most splendid before the term was invented.

Jim’s legacy in the world of headache is safe: as long as clinicians are taking a careful history and trying to understand the why and how of the patients they seek to serve, his contributions will endure. He was a doctor to his patients, a physician‐teacher to his students and a clinician‐scientist to the disease’s he sought to ameliorate.

Jim will be missed: by Judy, by his children, by his colleagues, by his patients and by me.

Headache medicine was better with him, sadder without him, yet always greater for him.