Mistakes we make in headache trials

Published on October 31, 2023   31 min
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Ladies and gentlemen, dear colleagues. I'm Hans-Christoph Diener, Chair of the Department of Neuroepidemiology at the University of Duisburg-Essen. For over 30 years, I ran a headache clinic. The topic of my talk is mistakes that we made in the past in headache trials. You may be surprised at the choice. There is a very easy explanation. Some years ago, I was invited to deliver a talk at an award ceremony. There were two people who got an award of which I was one. We were asked to tell about our major achievements in headache research. I thought if people hear from the first speaker about his achievements, it's most probably better for me as a second speaker to talk about some mistakes that my colleagues and I made in the last 30 years. In research, we learn from our mistakes.
This is my conflict of interest slide. Most of my research has been funded by the German Research Council and the German Ministry of Education and Research.
The whole story of triptans started in a very peculiar way. A pharmaceutical company had identified that venous vessels contain serotonin 5-HT, and had asked a group of pharmacologists to develop a drug for venous insufficiency targeting 5-HT receptors. But the drug did not work. However, safety experiments showed that it constricted meningeal arteries, and at that time, the pathophysiology of migraine was believed to involve vessel dilation in the brain and meninges during a migraine attack. Consequently, this led to the hypothesis that the drug might be used to treat acute migraine attacks.