'Migraine requires a gender-specific approach'
Migraine is a brain disease. If it were simple, we would have solved it already'. That is the title of the inaugural lecture delivered by Professor of Neurology Gisela Terwindt on Friday 3 June. In her speech she emphasises the importance of research into the differences between women and men with migraine.
Neurologist Gisela Terwindt's inaugural title is clear. Migraine is more complex and burdensome than is often assumed. She therefore believes that headache should be given a more prominent place in healthcare. For almost 30 years Terwindt has been dedicating herself to this within the headache centre of the LUMC.
Knowledge gap
‘Migraine is a brain disease with recurrent headache attacks’, explains the neurologist. ‘A person's susceptibility to having a headache attack seems to be influenced by internal factors, such as genetic predisposition and hormonal changes, in combination with external factors. These include sleep deprivation and alcohol.’ Terwindt emphasises that there is still a huge knowledge gap when it comes to triggers of migraine attacks. ‘In medical television series stress is often mentioned as the trigger for migraine while there is no proof whatsoever that this is the case. So we also have to do something about the representation.’
In the coming years Terwindt wants to closely monitor people with migraine using eHealth. ‘A good example of this is the E Diary we have developed. This gives us, but especially also the patient, much more insight into the triggers.’ Because attacks come and go, patients often have difficulty remembering characteristics of individual attacks. ‘This digital diary therefore provides a much better picture of possible triggers.’
‘By monitoring in the patient's own living environment, we can identify personal triggers for migraine.'
Personal triggers
In addition, Terwindt and colleagues want to investigate whether a change in brain activity can be measured prior to an attack. The idea is to combine these home measurements with the E Diary. ‘By monitoring in the patient's own living environment, we can identify personal triggers for migraine but also map out early signs of upcoming attacks.’ According to Terwindt, this approach benefits the healthcare system: ‘E-health applications contribute to personalised medicine and a reduction in treatment costs.’
Woman vs. man
Terwindt's research focuses primarily on the differences between women and men with migraine. This brain disease occurs three times more often in women than in men. Women with migraine also have a higher risk of developing brain and heart attacks than women without migraine. According to her, these gender differences in neurological diseases are not yet sufficiently examined. Terwindt has helped to set up several clinical studies that specifically look at migraine in women. Currently the HAT!-team is conducting a sex hormone study and a clinical study has started on the effect of continuous use of contraception in women with migraine.
‘Women experience more barriers during their careers than men, and that is not just to do with family responsibilities.’
Career barrier
As chair of the Women's Leadership Forum of the International Headache Association, Terwindt also makes a case for the 'leaky pipeline' in which talented women do not advance in the international headache field. ‘Women experience more barriers during their careers than men, and that is not just to do with family responsibilities’, says Terwindt. ‘We really need to do something about that.’
Photo: Flickr by Nenad Stojkovic