Doctors on the Case: Andrew Charles

Dr. Charles gives us a firsthand look at his migraine research and the steps being taken to alleviate migraine

This month we sat down with Dr. Andrew Charles to discuss his multidisciplinary approach to migraine research and the importance of educating both migraine patients and fellow colleagues on its impact. His belief is that as doctors and patients continue to work together, we will finally bring migraine out of the shadows and acknowledge it as a real public health issue. Dr. Charles is the Director of the UCLA Goldberg Migraine Program, and Meyer and Renee Luskin Chair in Migraine and Headache Studies at UCLA.

Q&A with Andrew Charles, M.D.

AMF: What is unique about your approach to migraine research?

AC: We take a very multidisciplinary approach. I have a laboratory that does basic research in mechanisms of migraine, and we then try to apply the things we learn in the laboratory to our care of patients. Conversely, we take the things we learn from patients back to the laboratory to see if we can better understand the basic mechanisms of migraine. It’s bidirectional communication between the lab and the clinic.

AMF: Who would you say is most impacted by migraine?

AC: Everyone, honestly. From kids to adults, people of all ages are impacted. We see people from every single walk of life having migraine, and it’s certainly much more common in women of reproductive ages. But—practically speaking—we see young kids who are incapacitated and we see older folks who are incapacitated, so it really is a problem that is an equal opportunity disabler. It affects everyone.

AMF: How are you making a difference for all of those people?

AC: Well, in every way we can. It’s important to do basic research and to try and understand the mechanisms. We’re constantly looking for new treatments and we’re also looking to repurpose treatments that are out there already, which is what has been done for migraine a lot in the past. Are there medications that are used for other things?  Can we apply those somehow to migraine? But then also finding totally novel therapies—that’s our goal in the laboratory, and to apply new treatment approaches that are completely out of the box.

Education is important too, for both patients and colleagues. Traditionally, migraine is a topic that hasn’t received much attention in medical education, which is kind of amazing given how common and disabling it is. But we have to really teach students and our colleagues how to better treat headache patients. It’s important to try out the things we’re learning on patients, and perform monitoring studies where we identify whether there are changes in people’s symptoms or how they feel in the hours leading up to a headache. They may then be able to better treat the attack if they can catch it earlier in the process.

AMF: What do you think is the biggest obstacle migraine patients face?

AC: There are a lot of obstacles. One is the fact that there is no overt measurable manifestation of the problem. There’s no fever, no change in your heart rate—you basically have to believe the patient when they say they are suffering, so that’s something that’s challenging for medical professors, professionals, and family members. There’s often this kind of suspicion that somehow people are embellishing or they are not experiencing terrible pain. And again, when you can’t see it on a scan or measure it in terms of a physical parameter, that’s really challenging for patients.

Second would be the very serious misperceptions of the disorder that have been historically propagated and allow for misunderstanding. It’s only recently that we are understanding that this is a disorder that involves dramatic changes in multiple parts of the nervous system. In the past, it was thought that it was a blood vessel problem where there’s constriction and dilation of blood vessels. Now that we can actually see very dramatic changes in brain function in migraine patients, we’re finally able to put forward a better picture of what’s happening. Therefore, physicians and patients can understand that this is not just something that is “in their head,” but is a disorder that is characterized by a lot of impressive changes in the nervous system.

AMF: Is there anything else you want to add that we didn’t cover?

AC: I guess I would end by emphasizing how extraordinary, common, and complex a problem this is. People are shocked when they hear the numbers about how many people are suffering from migraine worldwide and the fact that it’s highly variable. For some people, it’s occasional and easily managed with current therapies, but what’s so astonishing when you sit in our chair in the clinic is how many people across the country and throughout the world are devastated by this problem. I think that’s something that is critically important for people to understand. Migraine has been in the shadows, but it’s time for it to be brought forward as the major public health issue that it is.

Dr. Charles and his colleagues are part of a group of doctors leading the movement against migraine. By having these conversations, we hope to bring more attention to their ongoing work and the potential solutions that could help fight migraine. The American Migraine Foundation is committed to driving and supporting the impactful research that will lead to treatment advances for patients with migraine and other disabling diseases that cause severe head pain. Visit our website to learn more about our mission and current initiatives.