In Context

1050 www.thelancet.com/neurology Vol 9 November 2010

Thankfully, many neurological disorders are rare, but migraine aff ects about 10–30% of people at some point in their lives. This high prevalence is precisely why Jes Olesen, professor of neurology at the University of Copenhagen and chief of the Danish Headache Center at Glostrup University Hospital, Copenhagen, Denmark, chose migraine as his specialty.

“I was very socially minded”, says Olesen. “I thought that these big population diseases—the ones where everybody knows about it, everybody has met people who have it—that they received far too little interest, especially from neurologists.”

This social-mindedness turned Olesen off his fi rst career plan. “I originally thought about becoming a historian because history has been one of my big hobbies”, Olesen says. “But then I thought it was too theoretical for me; I would be too much removed from the world.” So Olesen headed for medicine, with the initial aim of becoming a family doctor.

The decision to specialise instead came after Olesen fi nished his medical degree at the University of Copenhagen. “I realised that I could either know a little about a lot or know a lot about a little, and it didn’t appeal to me to be too broad”, he says. Why neurology? “Obviously”, he chides jokingly, “because the brain is such a fascinating organ!”

Olesen began a long period of training in neurology, primarily in Copenhagen but with two stints overseas; fi rst at the National Hospital for Neurology and Neurosurgery in Queen Square, London, UK, and then at Cornell Medical Center in New York, USA. His experiences at these two world-renowned centres could not have been more diff erent, he says.

The National Hospital in London, Olesen says, “showed me how far you can get when you subspecialise…but it also showed how you can remove neurology from the reality of modern medicine—it was a really isolated place.” Although the neurologists were the best in Europe and provided far superior teaching to what he had experienced in Copenhagen, says Olsen, they mainly dealt with referral patients who had chronic problems, he explains. At Cornell, on the other hand, neurologists had more opportunities to interact with regular sick people—probably thanks to the ethos of the departmental chair, Fred Plum, says Olesen. This hands-on mindset fi tted better with Olesen’s social conscience.

Both New York and London suited Olesen’s appetite for culture. “It was incredible for me, having been raised in a rural area, to come to these two big cities of the world. I really took all the opportunities that were off ered

by the cultural scene.” Olesen is a fan of opera: “I’m not extremely knowledgeable; I’m just a consumer of opera”, he disclaims. But he is a big consumer, so he spent a lot of time at the Royal Opera House in Covent Garden, London, and at the Lincoln Center in New York. One evening in the early 1970s, he saw a very young Pavarotti perform at the Lincoln Center. “I thought it was just incredible that you can sing like that”, he reminisces. Olesen is still a regular opera attendee, going about six or seven times a year. Between visits, he watches operatic movies on his home cinema.

Olesen returned to Copenhagen in 1973, becoming an associate professor at the university in 1975, full professor in 1985, and founding and heading the Danish Headache Center in 2001. Over the past 30 or so years, Olesen has worked on brain blood fl ow and cerebral cortex changes associated with migraine. He has also worked on classifying and defi ning diff erent types of headache in his role as chair of the classifi cation committee of the International Headache Society. He has helped identify a number of molecular targets—including nitric oxide and calcitonin gene-related peptide—for potential migraine drugs, and has been involved in multiple drug trials. In recognition of his work, on March 15, 2010, Olesen was awarded the prestigious Lundbeck Foundation Nordic Research Prize worth 2 million Danish Krone (about €300 000).

Some of Olesen’s early trials were of triptans—drugs that specifi cally bind a type of serotonin receptor. “It was a huge advance when [triptans] arrived, for several reasons. One because they are very eff ective and have relatively few side-eff ects, and two because they are so selective”, says Olesen. This selectivity, he says, “was perhaps the best evidence that we ever had that migraine is a neurobiological disorder”. Migraine was often mistakenly labelled as a psychosocial disorder, explains Olesen.

Despite acceptance of migraine as a neurological disorder, the specialty remains dramatically underfunded. “There is a tendency to disregard it because people think, well my wife has migraines too, but she takes care of everything and she does her job, so it’s not a bad disease. They don’t grasp that it’s an extremely common disorder and you have it in all kinds of severities.” Instead, says Olesen, the very fact that it is common should be reason enough for proper funding: “We still haven’t got through to the general decision-makers that they could actually get a lot out of their money if they invested in headache research.”

Ruth Williams

Profi leJes Olesen: the people’s neurologist