Dr Mark Thaller took up his Headache consultant post in April. This has given him cause to reflect on his career path and how different events guided him along the way, although they weren’t always obvious signs.
It's never too soon to be interested in headache
Headaches are the commonest neurological condition. It is very likely that you have either personal or professional experience of them. From a clinical perspective having a specialist interest in headache is so rewarding, you are almost wholly reliant on your history taking skills, and you can also make such a difference to your patients and their families. In addition, as treatment options are rapidly increasing, expansion of services for sufferers is overdue across healthcare. It is an exciting time to be involved, and I have been lucky that my path has been illuminated by good mentors and role models.
Sowing the Seeds
Neuroscience never made much sense to me as a student. I remember vividly the hours required in my 2nd year of medical school to learn it (not that successfully). This changed during my practical neurology placement in my 4th year at Cardiff, which was excellent, and Dr Tom Hughes made it click into place simply. In hindsight this is a rare talent and a goal of mine when I teach. As a result, I subsequently did a research project the following year looking at the inter-rater agreement of the neurological examination (it is available online if you'd like a read). This led to my first presentations and publication.
An Unexpected Event
Despite this, neurology was not my planned speciality. I liked the holistic approach of primary care with the importance of history taking within the consultation and the continuity of care (although I know now that this is often not possible). However, I messed up the interview. In round 2, I applied both for GP and core medical training (as it was then). The latter however offered me both placements in stroke and in neurology over the 2 years. Was that a sign? I took it, and my career path then became a neurological one.
Deciding my subspecialty
When I began thinking about a neurology subspecialty interest during my registrar training, I looked for guidance. My best advice was from Dr Brendan Davies, currently the Chair of BASH, "Pick a subspecialty that you enjoy but also think about where it will be in 5 years when you are looking to become a consultant."
This is very good advice as you not only need a job to be available once you complete your training, but you’ll also be doing it for 30+ years. For me, he was, and still is, an excellent role model and a significant motivator to pursuing headache as my chosen subspecialty.
Academic "diversion"
With the first pandemic lockdown, healthcare became very COVID19 orientated, and most additional services were paused. So, I was in need of a change of focus and started my academic career. As the saying goes 'Better late than never'. This morphed into a PhD in Birmingham in Idiopathic Intracranial Hypertension (IIH), a condition in which people often have debilitating headaches and can develop visual loss. This research started off with identifying the detrimental impacts of the first lockdown on IIH patients and developed into evaluating long term outcomes, including in pregnancy.
In terms of how this helped me in my path to be a headache consultant, it taught me deep phenotyping, problem solving and time management skills. My supervisors, Prof Alex Sinclair and Prof Susan Mollan, were excellent. They motivated me, guided my research and helped me develop my headache knowledge. A big bonus was that they also enabled me to establish a decent publication rate.
On Reflection
You may be reading this as a new BASH member, or maybe a long standing one, or maybe someone has sent this onto you for a read. Just remember there is no right path and the finish line keeps moving at each stage you reach, so make sure there is something in what you do that you enjoy and makes it worth while.
Be guided by your role models, both good and bad, to shape you into the person you want to become.
Lastly, always be willing to learn, ask questions and remember that ultimately, we are here for our patients.
To find out more about my research, please read my main articles at:
- Thaller M, Hughes T. Inter-rater agreement of observable and elicitable neurological signs. Clin Med (Lond). 2014 Jun;14(3):264-7. doi: 10.7861/clinmedicine.14-3-264
- Thaller M, et al. The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes. J Neurol. 2023 Feb;270(2):851-863. doi: 10.1007/s00415-022-11402-6.
- Thaller M, et al. Idiopathic intracranial hypertension: Evaluation of births and fertility through the Hospital Episode Statistics dataset. BJOG. 2022 Nov;129(12):2019-2027. doi: 10.1111/1471-0528.17241.
- Thaller M, Homer V, Mollan SP, Sinclair AJ. Disease Course and Long-term Outcomes in Pregnant Women With Idiopathic Intracranial Hypertension: The IIH Prospective Maternal Health Study. Neurology. 2023 Apr 11;100(15):e1598-e1610. doi: 10.1212/WNL.0000000000206854.
- Thaller M, et al. Managing idiopathic intracranial hypertension in pregnancy: practical advice. Pract Neurol. 2022 Aug;22(4):295-300. doi: 10.1136/practneurol-2021-003152.
Dr Mark Thaller
Consultant Neurologist
Queen Elizabeth Hospital Birmingham and Midland Metropolitan University Hospital
