Elizabeth W. Loder, M.D., M.P.H., is one of the leading migraine and headache specialists in the United States. Originally from North Dakota, Dr. Loder attended medical school at the University of North Dakota. She completed residencies in internal medicine and headache medicine at Falkner Hospital in Boston. Dr. Loder is currently Chief of the Division of Headache, Department of Neurology, at Brigham and Women's Hospital in Boston and Head of Research for the British Medical Journal.
She is a past president of the American Headache Society, and was the first woman to hold that position. In a recent article in The New Yorker, The Heroism of Incremental Care, Atul Gawande wrote about observing Dr. Loder in action helping a migraineur who was in desperate need of better treatment.
Q: Why did you specialize in “headache medicine?”
Dr. Loder: It was serendipity. I did my internal medicine residency at the Faulkner Hospital, which happened to be the home of the John Graham Headache Center. John Graham was an internist by training, so the clinic had a history of hiring internal medicine doctors rather than neurologists. I did a rotation there in the last year of my residency after a friend of mine urged me to try it. The Center was hiring and offered me a job.
At the time, I had a new baby and wanted a job with regular hours, so I took it and have never looked back. I had episodic migraines myself, so I was interested in the specialty, but if I hadn’t trained at the Faulkner I would never have realized working in headache medicine was a possibility.
Q: What do you tell patients who tell you they’ve “tried everything?”
Dr. Loder: There are some patients for whom existing treatments don’t work well. That’s a failing of medical therapy and not the patient’s fault. But in going back over a patient’s records and reconstructing the history of treatment, which can be complex and time-consuming, it’s very common to find that treatment trials might have been too short or the doses used too small. It’s also the case that combining treatments rather than using them alone in sequence can be effective where individual therapies have failed.
I’ve also been doing this long enough that I know that for a substantial minority of these patients who have “tried everything,” treatments may be effective when they are re-tried. I can’t think of a good explanation for that, but it happens often enough that in my opinion it is worth going through some of those things again, this time in a very methodical way.
Q: What’s the most important element in a doctor/patient partnership?
Dr. Loder: I think it is a common understanding of treatment goals. Depending on the situation, this might be total elimination of headaches, but more often it is making things better although not a cure.
Q: If all of your patients could understand and believe one thing, what would it be?
Dr. Loder: Numbers and data are important. You wouldn’t try to manage your diabetes without having some numerical information about your blood sugar levels, and you shouldn’t want to make important decisions about migraine and headache treatment without good data.
Q: Is the role of women in “headache medicine” changing? How? What do you think brought about those changes?
Dr. Loder: In my view, the changes in headache medicine mirror those that are occurring in medicine in general. This means that the number of female doctors in this field is increasing. This in turn is a reflection of societal changes that have made it possible for more women to pursue medical careers. I believe that eventually we will outnumber men in the field, and that women will become more prominent in leadership of the specialty.
It's been my pleasure to get to know Dr. Loder and to be able to consider her one of my mentors in the migraine world. I've always been impressed by how how she blends her career with the rest of her life to keep everything so well balanced. When I asked her to share a bit about what she does when not working, she told me:
"When I’m not working I enjoy reading and gardening. My husband and I are reading the novels of Barbara Pym aloud and I love them. I’ve joined the Barbara Pym Society and plan to go to their spring meeting here in Boston. For relaxation I find there is nothing better than a cozy mystery: nothing too violent or grim, please. Right now I am working my way through the books of Hazel Holt, who as it happens was a friend of Barbara Pym’s and her literary executor. As for gardening, I’m especially interested in herbs, berries, and fruit trees. I certainly grow flowers — peonies, lilacs, and hollyhocks are my favorites — but I always come back to plants that are useful as well as lovely. That means things like quince, red currants, and rhubarb. I also have a medlar tree. I make lots of pies and jelly. I dry many of my herbs for potpourri and make herbal hydrosols that I use when I iron."
More profiles of people in the migraine and headache community:
© Teri Robert, 2017.