Before Migraine Was a Disease: Headache Expert Christopher Gottschalk, MD, Remembers his Roots

Headache expert Christopher Gottschalk, MD, professor of clinical neruology, director of headache medicine, and section chief, general neurology, at the Yale School of Medicine recounted his path to a subspecialty in headache medicine in a recent interivew with Patient Care Online.

Gottschalk said his interest began to deepen at a time when there were few headache specialists in the US and when the traditional view of headache in scientific circles was dismissive. The prevailing sentiment was that “headache wasn't really a problem, that it certainly wasn't a neurological problem, that it barely qualified as a medical problem,” he said.

In this short video, Gottschalk recalls his realization of how widespread the problem of migraine was, the magnitude of the associated disability among patients, and the signficant and stubborn prejudice against recognizing this head pain as the complex neurlogic disease it is.

(Note transcript below for areas of video that may be unclear.)

Christopher H. Gottschalk, MD, is professor of clinical neurology, director of headache medicine, and section chief, general neurology, at the Yale School of Medicine in New Havent, CT. Gottschalk is also current president of the Alliance for Headache Disorders Advocacy.

The following transcript has been edited for clarity and style.

When I was in medical school and residency at Columbia, in New York, there were no headache specialists anywhere to be found in our system. Most of my preceptors at that time, who were world class experts in other areas of neurology, had the same traditional sort of dismissive view that headache wasn't really a problem, that it certainly wasn't neurological problem, and barely qualified as a medical problem.

But when I was finishing medical school and moving on to residency, my fiancée at the time was moving into her PhD work in epidemiology. And she would come home from her classes saying, “Gosh, you know, I talk to this guy in my class who runs a headache program at Montefiore [Montefiore Medical Center, Bronx, NY]. And he keeps telling me all these fascinating things about how common migraine is, how the epidemiology is just becoming clear, how underrecognized it is," etc. This turned out to be Richard Lipton, who was doing his PhD in epidemiology at the same time, having already established himself as a major force in that field.

I began talking to Dr Lipton and then I started doing a part-time fellowship during my residency, and then my research fellowship, at Montefiore, a few years back when Larry Newman was still there. So, my introduction to headache as a specialty and science was fortunately early. And I maintained my connection to it when I moved into clinical practice after that, opening up headache centers in various parts of Connecticut before joining Yale to create a headache medicine program there.

I have to say that part of what attracted me to it was the idea that this was a problem that was underrecognized. But there was something that just didn't sit right with me about the attitude that was often presented; that somehow these were women who were just weak or whining or trying to get out of something, but not really suffering with a disease. And that did not in any way jive with my experience growing up, or in college, or in a series of laboratories all run by strong willed, driven women who don't match that idea of a woman trying to get out of anything.

It seemed to me that suddenly adopting a different mindset about what this disease was and how it affected people, and the great disparity between what the reality is living with it, and how people dismiss it or view it or explain it was a good challenge—and a fascinating statement about how we approach many problems.