MIGRAINE: DIAGNOSIS, TREATMENT AND UNDERSTANDING c.1960–2010 The transcript of a Witness Seminar held by the History of Modern Biomedicine Research Group, Queen Mary, University of London, on 28 May 2013 Edited by C Overy and E M Tansey Volume 49 2014 ©The Trustee of the Wellcome Trust, London, 2014 First published by Queen Mary, University of London, 2014 The History of Modern Biomedicine Research Group is funded by the Wellcome Trust, which is a registered charity, no. 210183. ISBN 978 0 90223 894 7 All volumes are freely available online at www.history.qmul.ac.uk/research/modbiomed/ wellcome_witnesses/ Please cite as: Overy C, Tansey E M. (eds) (2014) Migraine: Diagnosis, treatment and understanding c.1960–2010. Wellcome Witnesses to Contemporary Medicine, vol. 49. London: Queen Mary, University of London. CONTENTS What is a Witness Seminar? v Acknowledgements E M Tansey and C Overy vii Illustrations and credits ix Abbreviations and ancillary guides xi Introduction Giles Elrington xiii Transcript Edited by C Overy and E M Tansey 1 Appendix 1 Theories of migraine 1900–1960: a brief background to the Wellcome Witness Seminar Mark Weatherall 87 Appendix 2 Summary of the classification of primary headaches, adapted from the Headache Classification Committee of the International Headache Society (IHS) (2013), 636–37 91 Appendix 3 The Role of the UK Specialist Nurse in Headache Ria Bhola and Victoria Quarshie, Headache Nurse Specialists 93 Biographical notes 99 References 111 Index 125 Witness Seminars: Meetings and Publications 137 WHAT IS A WITNESS SEMINAR? The Witness Seminar is a specialized form of oral history, where several individuals associated with a particular set of circumstances or events are invited to meet together to discuss, debate, and agree or disagree about their memories. The meeting is recorded, transcribed and edited for publication. This format was first devised and used by the Wellcome Trust’s History of Twentieth Century Medicine Group in 1993 to address issues associated with the discovery of monoclonal antibodies. We developed this approach after holding a conventional seminar, given by a medical historian, on the discovery of interferon. Many members of the invited audience were scientists or others involved in that work, and the detailed and revealing discussion session afterwards alerted us to the importance of recording ‘communal’ eyewitness testimonies. We learned that the Institute for Contemporary British History held meetings to examine modern political, diplomatic and economic history, which they called Witness Seminars, and this seemed a suitable title for us to use also. The unexpected success of our first Witness Seminar, as assessed by the willingness of the participants to attend, speak frankly, agree and disagree, and also by many requests for its transcript, encouraged us to develop the Witness Seminar model into a full programme, and since then more than 50 meetings have been held and published on a wide array of biomedical topics.1 These seminars have proved an ideal way to bring together clinicians, scientists, and others interested in contemporary medical history to share their memories. We are not seeking a consensus, but are providing the opportunity to hear an array of voices, many little known, of individuals who were ‘there at the time’ and thus able to question, ratify or disagree with others’ accounts – a form of open peer-review. The material records of the meeting also create archival sources for present and future use. The History of Twentieth Century Medicine Group became a part of the Wellcome Trust’s Centre for the History of Medicine at UCL from October 2000 to September 2010. It has been part of the School of History, Queen Mary, University of London, since October 2010, as the History of Modern Biomedicine Research Group, which the Wellcome Trust funds principally 1 See pages 137–142 for a full list of Witness Seminars held, details of the published volumes and other related publications. v under a Strategic Award entitled ‘The Makers of Modern Biomedicine’. The Witness Seminar format continues to be a major part of that programme, although now the subjects are largely focused on areas of strategic importance to the Wellcome Trust, including the neurosciences, clinical genetics, and medical technology.2 Once an appropriate topic has been agreed, usually after discussion with a specialist adviser, suitable participants are identified and invited. As the organization of the seminar progresses and the participants’ list is compiled, a flexible outline plan for the meeting is devised, with assistance from the meeting’s designated chairman/moderator. Each participant is sent an attendance list and a copy of this programme before the meeting. Seminars last for about four hours; occasionally full-day meetings have been held. After each meeting the raw transcript is sent to every participant, each of whom is asked to check his or her own contribution and to provide brief biographical details for an appendix. The editors incorporate participants’ minor corrections and turn the transcript into readable text, with footnotes, appendices, a glossary and a bibliography. Extensive research and liaison with the participants is conducted to produce the final script, which is then sent to every contributor for approval and to assign copyright to the Wellcome Trust. Copies of the original, and edited, transcripts and additional correspondence generated by the editorial process are all deposited with the records of each meeting in the Wellcome Library, London (archival reference GC/253) and are available for study. For all our volumes, we hope that, even if the precise details of the more technical sections are not clear to the non-specialist, the sense and significance of the events will be understandable to all readers. Our aim is that the volumes inform those with a general interest in the history of modern medicine and medical science; provide historians with new insights, fresh material for study, and further themes for research; and emphasize to the participants that their own working lives are of proper and necessary concern to historians. 2 See our Group’s website at http://www.history.qmul.ac.uk/research/modbiomed (visited 8 April 2014). vi ACKNOWLEDGEMENTS The topic of ‘Migraine: Diagnosis, treatment and understanding c.1960–2010’ follows on from a Witness Seminar held in December 2012 on ‘Drugs affecting 5-HT systems’. We are very grateful to Dr Mark Weatherall for his help in the planning of this meeting and for his excellent chairing of the occasion. We also thank Dr Giles Elrington for writing the introduction to the volume, and Dr Patrick Humphrey and Dr Alec Oxford for providing images and documents to illustrate the proceedings. Our gratitude also goes to the Wellcome Library, London, for permission to use photographs from the meeting. As with all our meetings, we depend a great deal on Wellcome Trust staff to ensure their smooth running: the Audiovisual Department, Catering, Reception, Security and Wellcome Images. We are also grateful to Mr Akio Morishima for the design and production of this volume; the indexer Ms Liza Furnival; Mrs Sarah Beanland and Ms Fiona Plowman for proof reading; Mrs Deborah Gee for transcribing the seminar; Dr Julie Hartley, Ms Emma Jones, and Mr Alan Yabsley for assisting with running the seminar; and Mr Adam Wilkinson who assisted in the organization and running of the meeting. Finally, we thank the Wellcome Trust for supporting this programme. Tilli Tansey Caroline Overy School of History, Queen Mary, University of London vii ILLUSTRATIONS AND CREDITS* Figure A Dr Giles Elrington; reproduced with his permission xvi Figure 1 Dr Mark Weatherall and Professor Tilli Tansey 3 Figure 2 Dr Michael O’Brien 5 Figure 3 Professor Jes Olesen 7 Figure 4 Dr Patrick Humphrey 8 Figure 5 Professor Merton Sandler 9 Figure 6 Mrs Mary Ayres, Professor Anne MacGregor and Professor Merton Sandler 10 Figure 7 Dr Glyn Volans and Dr Richard Peatfield 12 Figure 8 Dr Jeffrey Aronson, Mrs Mary Ayres, Professor Pramod Saxena (speaking), Professor Anne MacGregor, Dr Alec Oxford, Dr Tom Blackburn 16 Figure 9 Dr Patrick Humphrey and Dr Tom Blackburn 23 Figure 10 Professor Trevor Jones 24 Figure 11 Wellcome Foundation Ltd advertisement proof: Ralph Steadman cartoon for Migril, c.1979. Credit: Wellcome Library, London 25 Figure 12 Dr Alec Oxford 36 Figure 13 Chemical structure of some 5-HT agonists. Figure provided by Dr Alec Oxford 37 Figure 14 Letter to Dr Patrick Humphrey thanking him for his part in the development of sumatriptan. Document provided by Dr Patrick Humphrey 43 * Unless otherwise stated, all photographs were taken by David Sayer, Wellcome Trust, and reproduced courtesy of the Wellcome Library, London. ix Figure 15 The sumatriptan discovery team. Photograph provided by Dr Patrick Humphrey 45 Figure 16 Mrs Wendy Thomas 48 Figure 17 Dr Jeffrey Aronson and Dr Richard Peatfield 49 Figure 18 Dr Richard Peatfield and Dr Jeffrey Aronson 53 Figure 19 Dr Goadsby and Professor Humphrey after their debate at Whistler, BC, Canada in 1993. Photograph provided by Dr Patrick Humphrey 62 Figure 20 Dr Mark Weatherall, Professor Brian Hurwitz, and Dr Michael O’Brien 68 Figure 21 Professor Tilli Tansey and Mrs Mary Ayres 70 Figure 22 Mrs Vicky Quarshie; reproduced with her permission 72 Figure 23 Professor Anne MacGregor, Dr Katherine Foxhall, and Mrs Mary Ayres 78 Table 1 Outline programme for ‘Migraine: Diagnosis, treatment and understanding c.1960–2010’ Witness Seminar