The story behind a simple idea: rethinking headache care as a way to improve population health globally

In an era of changing landscape in global population health, improving the overall health of people suffering from headache disorders will be a feasible way to improve global population health.

This is the story behind a recent paper publishes on The Journal of Headache and Pain (Rethinking headache as a global public health case model for reaching the SDG 3 HEALTH by 2030. J Headache Pain. 2023; 24:140), but it is mostly the story of a journey on a mountain. It begun at the end of 2022 and get to its end on October 2023, when the manuscript was finally online.

The paper moves from a simple observation and gets to a simple idea. The observation is the populations’ health is defined by the way in which people experience health conditions that limit their daily lives, and the more a disease is common in the population, the higher the likelihood that it is a main cause of population disability. Headache disorders are common and disabling: so, and here comes the simple idea, if we want to improve populations’ health, we have to improve the health of people who suffer from headache disorders. A simple idea which, however, will have a complex realization: and our paper, rather than practical solutions, presents general guidelines that can be implemented in the future.

Coming back to the story behind this paper…it is not so frequent that a middle-level researcher is given the role and the responsibility to coordinate a group of high-level scientists. Actually, one of the strongest group possible in the field of headache disorders, composed of past, current and future presidents of scientific societies and journal editors. Compared to all of them, I felt like a mouse that had to climb Mount Everest. And by “not so frequent” I mean that it was the first time for me.

When I first was informed about the possibility to work on this manuscript, in which six sub-sections had to be merged in order to give a readable shape to such an enormous amount of content, I was told that I would have to care about one of the sections. It was the end of 2022:  I thought it was prestigious, but manageable, and in fact it was. Someone had however to prepare an introductory section: when I received the formal invitation to join this collective effort, I discovered that this task would have been in charge to me. It was February 2023: I still thought it was prestigious, but manageable, and in fact it was. Then, someone had to collate all the material, which means finding and deleting the inevitable text duplication (some of which surely “escaped” my radar), as well as filling the inevitable gaps, fixing the style and setting the references (a task which might possibly drive anyone crazy): still me, still prestigious, manageable, although hard. And finally, someone had to write down a conclusion. “No one knows this manuscript better than me”, I thought: so, I decided to take this responsibility by myself. A that point I get back to the two senior authors that were in charge to handle the manuscript with me: they took some time for a full reading of the whole manuscript and provided some comments. But you cannot submit such a kind of manuscript without a last revision from the co-authors.

So, the mouse started climbing Mount Everest. I have to admit that it never happened to me to get such a large amount of comments: however, the topic is of high-level importance as it provides a unique opportunity, to a group or individual researchers - and not to a scientific society - to set a policy agenda on how should headache care be organized at the global level. Of course, in principle and not in practice: but the principles behind are strong and a point of balance had to be found. I expected that working with such top-level scientists would have been complex. On previous occasions, I saw people having harsh discussions because the comment they made was not retained. Nothing of this kind happened on this occasion: I saw people providing further explanations to what they wrote, explaining the importance (and the reasons behind the importance) of their opinions. I saw people proving me a true global perspective, especially on what is realistic to write down and what is not, even considering that no practical indications would be given. Clearly, difficulties existed: when you have to coordinate the work with top-level people, you have to be flexible, especially on the agenda of revisions and on the timing to publication.

It was indeed a great opportunity to challenge myself and learn the meaning of serving as group leader, and for this I would like to quote piece of Roberto Benigni’s masterpiece “Life is Beautiful”: You are serving, but you are not a servant. Serving as senior author enabled me to learn something: I learnt that there was no mouse, and no Mount Everest to climb. But, more important, that in this journey I was not alone, but in good company of 25 companions, that before being excellent scientists, are all exceptional persons.

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