The Robert Wartenberg Lecture: Peter Goadsby takes migraine on the podium

As the 2023 Topic Chair for Headache for the American Academy of Neurology (AAN) annual meeting held in Boston, Massachusetts, it was a delight to see so many of our International Headache Society (IHS) United States members celebrate the 75th anniversary meeting with many of our IHS members from all over the world including friends from Italy, Denmark, Brazil, Japan, and New Zealand to name a few. In addition to the high-quality educational sessions and scientific headache presentations which were well represented, migraine was a focus of the Presidential Plenary Session held on Sunday, April 23th, 2023.  Professor Peter Goadsby, Past-President of IHS, was honoured with the Robert Wartenberg Lectureship, which (not coincidentally) was also given to his late mentor and past IHS president, Jim Lance.  Professor Robert Wartenberg was a highly regarded clinical neurologist and German professor who immigrated to the United States, settled in California, and ended his career teaching at the University of California in San Francisco.

During Professor Peter Goadsby’s honorary lecture, Migraine: then, now, and tomorrow- Progress through Biology, he reflected on the global burden of migraine, the biology, and the road to identifying successful therapeutic targets including some investigations on the trigeminovascular system and calcitonin gene related-peptide (CGRP) with his collaborator and past IHS president Professor Lars Edvinsson. He reflected on what has gone right as well as what went wrong, yet taught us something about biology.  In the lecture, he provided a fascinating history of migraine therapeutics, starting with ergotamines and triptans which carry some capacity for sensitization, to gepants that aren’t associated with medication overuse headache (all driven by biology). He said that “we need data driven ways of designing our clinical trials by welcoming participants with preventive failures, which have low placebo rates.”  In addition, he emphasized the opportunity to accelerate translational research from bench to bedside, by speaking to and partnering with patients.  CGRP inhibitors are now available in over 80 countries around the world.

He reviewed the science of premonitory symptoms, which was originally described by British neurologist Williams Gower centuries ago. “Migraine is not a linear disorder, it is a network disorder with many targets, and new opportunities to stop migraine pain before it starts.”  During the scientific headache sessions, Emergent Sciences and Top Headache Research and Advances in Migraine Therapeutics, several investigators characterized the premonitory phase and presented positive results of ubrogepant, supporting the use of gepants during the premonitory phase to prevent headache.     

During his lecture, he thanked his trainees as well as all mentors and teachers for their dedication.  Looking forward, he announced the positive results of the anti-PACAP antibody randomized control trial for migraine.  He also invited trainees to “get a ticket on the headache express”, a career that is enjoyable because we can make patients better with the understanding that “its biology changing clinical practice.”  I look forward to the excitement continuing at the International Headache Congress meeting, held in Seoul, South Korea, September 14,-17th, 2023. 

Tesha Monteith, MD, FAAN, FAHS
Associate Professor, Clinical Neurology
University of Miami, Miller School of Medicine
Member, IHS Board of Trustees