In Context

1088 www.thelancet.com/neurology Vol 7 December 2008

Profi leRichard Lipton: migraines, magnets, and much, much moreRichard Lipton, Director of the Montefi ore Headache Center, in New York, USA, is a hero for people with headache everywhere. But in addition to being a master of migraine research, Lipton is also a specialist in cognitive ageing and dementia. Despite his many-feathered research cap—evidenced by the many professorships he holds at Albert Einstein College of Medicine, NY, USA—Lipton is a remarkably reserved man, unpretentious, and thoroughly down to earth.

For such an understated fellow, Lipton has certainly had his share of glamour this summer. He has appeared on ABC national news, CBS national news, and has even turned down a few requests to appear on television shows. This fl urry of media interest surrounded a yet to be published study by Lipton that shows that transcranial magnetic stimulation (TMS) could be used to treat a certain type of migraine. Lipton, who has worked in headache research for more than 20 years, was surprised by all the attention, and typically downplayed the fuss, suggesting it probably arose because magnets for migraines “sounds semi-crackpot”.

Lipton has published extensively on the diagnosis, epidemiology, risk factors, and treatment of headache, and he is undoubtedly one of the leading experts in the fi eld; therefore, to learn that his interest came about through a need to pay the bills was a surprise. “My wife and I bought an apartment in Manhattan, and I couldn’t aff ord the mortgage”, recounts Lipton. To make some extra money Lipton considered moonlighting at the Montefi ore Headache Center. “My wife said, ‘don’t do it; we’ll be ok; we don’t need the money that badly; you’re gonna get distracted from what you’re really interested in’. I said, ‘no no no’…but she was right, I did get distracted. Very distracted.”

Lipton’s work on headache accounts for about half of his research time. The other half is devoted to cognitive ageing and dementia—his fi rst research interest when he joined the faculty at Albert Einstein College of Medicine and the area that his wife was so worried would suff er. It didn’t. The tools and research processes Lipton uses to study the two areas are similar. He looks at behavioural, environmental, and genetic risk factors, assesses biological markers and neuroimaging correlates, and does clinical trials.

Lipton and his collaborators have identifi ed several risk factors for migraine and dementia, many of which are remediable. In the case of migraine, for example, stress and caff eine intake are risk factors for progression from occasional to more frequent migraines. And in dementia, the absence of cognitively stimulating activity increases

the risk of Alzheimer’s disease. His hope for both fi elds is that identifying the risks will help people to adopt preventive behaviours. Some risk factors, such as obesity and depression, are common to migraine and dementia. The two fi elds also overlap more directly. “There’s very good evidence that pain causes cognitive changes, some of which may predispose to dementia”, explains Lipton, who welcomes the opportunity to combine his areas of interest.

Lipton’s work on cognitive decline has recently taken on added poignancy because his mother has been diagnosed with Alzheimer’s disease. “It feels to me like everyone I know has migraines, and that’s ok”, he says. “But my mother having Alzheimer’s is not ok. That’s really hard.”

One way that Lipton deals with the problem is by putting pen to paper and “translating emotion into metaphor”. Lipton is a keen poet and says that the process of writing is a release. He has been writing poems for as long as he can remember and has even published a few. “And I’ve had many rejected by the New Yorker”, he laughs. Poetry is not only a good stress reliever; Lipton says that writing for pleasure is actually protective against dementia.

Lipton’s love of poetry and literature could well have led him down a diff erent career path. In college he started out studying English. But then, as he puts it, he “slid down a reductionist ladder”: he started dabbling in philosophy, then moved towards psychoanalysis and literature; then he slid even further to psychology; then to physiology and psychology; and eventually ended up researching neurotransmission at University College London, UK. “The whole time I was interested in what it means to be a human being”, says Lipton, “but at that point [studying neurotransmission] I discovered that the human being disappeared”. He thus moved back up a few rungs and enrolled in medical school. A year in clinical research studying schizophrenia cemented his passion for disorders of the brain, and he has never looked back.

Lipton believes that “the wonderful thing and the horrible thing about neurology is the same thing; and that is that neurological diseases aff ect what makes us human…the disorders are [thus] stunningly fascinating but also heartbreaking”. Since he started out in the fi eld, he has seen it gradually shift from being a diagnosis-oriented specialty to a treatment-oriented specialty. “And that’s all to the good”, he says, “because observing how the brain makes us human is fascinating, but helping people preserve their humanity is much, much better.”

Ruth Williamsruth.williams@absw.org.uk