Interview with Drs. Jack Gladstein & Christina L. Szperka & Amy A. Gelfand
Why did you feel that it was important to write Pediatric Headache? What does your publication add to the field?
Jack Gladstein: This is the first text on pediatric headache that gears each chapter to both primary care and specialists. It focuses a lot on empowering families and offers practical solutions and best practices.
Christina Szperka: Children with chronic headache diseases have substantial disability, but migraine, the most common disabling primary headache disorder, is underdiagnosed and undertreated. We wanted to increase awareness and provide a reference for patients and their parents, primary care clinicians, and specialists who care for kids with headache.
Amy A. Gelfand: Headache disorders are incredibly common in children and adolescents; however, they tend not to be given the attention they deserve. Migraine and other headache diseases are “invisible illnesses”–meaning there is nothing visible or verifiable that outside observers can see. This is different from something like a broken leg, which can be seen on an X-ray, and where others can see that something is hurt because there is a cast. It is also unlike diseases such as diabetes where something like a glucose level can be objectively measured and shown to others. In migraine, the person experiencing it is the sole source of information about the existence and severity of pain and other symptoms, and the disability that they cause. Sometimes this leads to others not believing them, because there is nothing others can “see” or verify, and the person may “look fine”. There is also a lot of stigma around migraine and other headache disorders–perhaps because of their being invisible diseases, and/or that migraine disproportionately affects women and adolescent girls. Migraine research is highly underfunded relatively to the amount of disability that it causes. This book will hopefully raise the level of awareness among clinicians about migraine and other headache disorders in children and adolescents, improve rate and accuracy of diagnosis, and lead to more kids getting effective treatment earlier.
What is the most exciting aspect of your new publication? What chapter or topic covered are you most excited about?
Jack Gladstein: It is one thing to write a book for a specific audience. It is another to focus efforts on families and practitioners from both primary care and specialty care. I especially like the chapter on advocacy. People with headaches are often discounted by schools and the workplace. We offer suggestions, websites, and organizations to help advocate.
Christina Szperka: The format of including information for families, PCPs, and specialists in each chapter. I am excited that we covered everything from epidemiology to pathophysiology to the multiple facets of treatment. The strength of this book is in the authors, who include dozens of doctors, psychologists, advanced practice providers, and patient advocates. We tried to provide the full range of knowledge that might be helpful.
Amy A. Gelfand: I think the most interesting thing is how each chapter has three sections–one for specialists, one for generalists, and one for patients/families. That is unusual and I think makes this book special.
Who will find the greatest value from Pediatric Headache and why?
Jack Gladstein: First of all, patients and families will gain a better understanding of their (or their child’s) condition. Primary care folks can know what to ask, and what to expect from their specialist colleagues, and be more comfortable assessing and treating children with headache. Specialists will have up to date information as well as have access to tools, and best practices in the field.
Christina Szperka: Patients and parents. There is so much information that we can’t relay in a typical clinical visit. This book summarizes the currently available information and can serve as a starting point for conversations with your child’s clinician.
Amy A. Gelfand: Primary care pediatric clinicians—there is a lot of material in the book that is written specifically with this group in mind. In addition, primary care pediatricians can read the content that is written for patients and families and gain ideas for how to describe various things to them.
What new ideas, practices, or procedures do you hope your readers take away from Pediatric Headache?
Jack Gladstein: I particularly appreciate the bio behavioral approach that can be adapted buy primary care as well as specialists. Chronic pain cannot be treated with medicine alone.
Christina Szperka: Hope. There is so much that can be done right now, and most kids will see substantial improvement quickly. For those kids who have been struggling and have not yet improved, keep hoping. There are many new treatments around the corner, and many people working to try to improve our understanding of and treatment of headache diseases.
Amy A. Gelfand: One of the novel things about this textbook is that we included content for patients/families, so it is not just for clinicians.
What problem do you hope the future generation of your specialty will be able to solve?
Jack Gladstein: We keep coming up with novel approaches for treatment. We still need to diagnose migraine earlier and afford rapid and effective treatment to avoid chronification. We hope to help families and their practitioners get a good handle on the diagnosis and treatment and make people healthier at a younger age.
Christina Szperka: Helping the children who do not see improvement with our typical first line therapies at this point in time.
Amy A. Gelfand: How best to help with children and adolescents with continuous headache and with difficult to treat migraine and other headache disorders.
Is there anything else about the book you’d like to say?
Jack Gladstein: I am proud of my co- editors and their hard work. We assembled experts from all over North America and asked them to provide material accessible to both families, primary care, and specialists alike. This was a hard task and they did a great job. It is a nice read, and a joy to put together!
Christina Szperka: Thank you for this opportunity. We hope we can help patients to improve, and parents and clinicians to feel empowered!
Amy A. Gelfand: We hope it will be useful.
About the Authors:
Jack Gladstein, MD: I am professor of pediatrics at the U of Maryland School of medicine. I started the pediatric headache clinic in 1987. At the time it was the second such program in the US.
Christina Szperka, MD, MSCE: Director, Pediatric Headache Program at the Children’s Hospital of Philadelphia. I decided to become a neurologist because my parents ran group homes for children and adults with intellectual disability but turned to specializing in chronic pain due to personal experience.
Amy A. Gelfand, MD: Director of UCSF Child & Adolescent Headache Program. I’m a child neurologist and pediatric headache specialist.
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