A Discussion with Neil Andrews From the Migraine Science Collaborative

Announcer: Welcome to the Vets First Podcast, a research-based conversation centered around the VA health care system, its services, and patients. From Iowa City, Iowa, here's your hosts: Dr. Levi Sowers and Brandon Rea. Levi Sowers: Welcome back to the Vets First Podcast podcast. As always, Brandon is here with me- Brandon Rea: Hello everyone! Levi Sowers: and today we are lucky to have Neil Andrews, who is the executive editor and science journalist for the Migraine Science Collaborative. Welcome, Neil. Neil Andrews: Thank you. It's great to be here with you guys. Levi Sowers: Yeah. So can you tell us a little bit about the Migraine Science Collaborative and what its goal is? Neil Andrews: Sure. So the Migraines Science Collaborative is a online publication and community really targeted towards migraine researchers and clinicians. And what we do is we cover migraine research from a journalistic perspective for our readers. So we do news, interviews, podcasts - we have some elements of a scientific journal, but really sort of the core thing that we do is we cover migraine research, whether it's animal research, research in cells, or research in people - anything with a research component, we cover. We try and write our articles in a way that is a little bit more widely understandable. So you don't necessarily have to be an expert, a physician or a researcher to get something out of our content. So that's what we do. And the overall goal, really, is to keep people on the cutting edge of research so they know what's going on and to sort of bring the migraine headache community together and get people talking, exchanging ideas. And, hopefully, in that way we can help raise awareness of migraine pain and get people thinking about it and hopefully advance research. Levi Sowers: Yeah, phenomenal. You know, we set out with the same thing when we started this first podcast is to communicate complex science issues to veterans. And selfishly, we've had several episodes on headache because we're interested in that. So, you know, I think that what the Migraine Science Collaborative does is good in that it really makes it understandable for the general audience to read it. Reading some of your articles and listening to your podcasts, it's really quite nice to hear it broken down in a way that people can understand. And so today we sort of have a joint episode with Neil. He's going to post this episode on the Migraine Science Collaborative and we're going to post this episode on Vets First Podcast’s website. Yeah, we're really looking forward to this conversation. So thanks for introducing the migraine science collaborators. Neil Andrews: Absolutely. Thanks for having me. It's great to great to be here and to be able to talk about it and to have this podcast with you guys. Levi Sowers: Yeah, So you can start with some questions for us if you want. Neil Andrews: Sure. Yeah. So I'm just really curious how you all started your podcast in the first place, why you decided to do it. I know you've been doing it for a while. How did you become interested in doing it and especially focusing on veterans? Levi Sowers: Yeah, so we started it in 2020, I don't know, about three years ago. So around 2020-2019. And you know, it actually was spawned out of out of a need to have better outreach for what's called the Center for the Prevention and Treatment of Visual Loss over at the VA here. And so when we were renewing that, it's an entity - a center of excellence, or what they used to call center of excellence, but I'm just going to call it that for now. And so at the VA, they have these centers that focus on particular types of research, and this one is vision related. And back in 2019-2020, when I was in still an Andy Russo's lab, Andy was a part of it, I was a part of it, and Brandon was a part of it. And we really like want it. We focused on photophobia and photophobia as a major problem in patients with migraine, veterans with post-traumatic headache and a bunch of other disorders. And so, you know, what does migraine have to do with the Vision Institute? Well, that's it for us. And so when we were renewing that grant or that award, we got dinged actually for not having enough outreach to veterans. And so I just was like, I went to the director and I was like, Hey, you should start a podcast or a series of TEDTalks to communicate this really complex issues and topics to veterans. And I brought Brandon on board with it, and we just started doing interviews. At first we bought some podcasting equipment, but now we just use Zoom because it's a lot easier to record and you can have video along with it too. But, you know, we started by interviewing some veterans and then we wanted to pair up researchers with those veterans and the topics or the problems that those veterans suffer from. So headache is a perfect example. So our very first season we had Andy Russo and we had a couple of veterans who have been or at least one veteran who benefited from the new sharp antagonist drugs that have been pretty successful in treating migraine. And so we had some really interesting stories from them, how they get into the military, what the VA has done to help them, good or bad. We don't really we don't really filter out the bad either. And so, you know, the VA is not perfect and so Brandon was really influential on that aspect, just keeping it raw and that that we wanted to have long term, long conversations with people about what was wrong with them and then have a researcher talk about that topic that's sort of a leader in the field. Brandon Rea: We thought it was important to that researchers or physicians that we have on are able to explain their work and what they're trying to do in an understandable fashion. And any line of work, especially as we get so used to that, the jargon that we use, that it can be hard to communicate effectively. But on the flip side, having people on our end be able to hear directly from the patients that this will benefit is also important so we don't get kind of lost in the weeds, if you will. Neil Andrews: Right. And I'm curious, you know, having interviewed veterans, are there common themes that you hear from them in terms of what they think about migraine and headache? Anything really stand out to you? Brandon Rea: I would say sometimes it can be hard to discern because a lot of the veterans that we've interviewed have post-traumatic headache, TBI, from experiences they’ve had. So it's interesting to hear them describe their headaches in that fashion when we work on migraine and somewhat on post-traumatic headache as well. Yeah, it's interesting to hear their approach, their insides with it because it's from, like, a military backdrop. Levi Sowers: Yeah. Yeah. And, you know, I think one of the biggest things is that they often feel neglected or not heard. So I think migraine is sort of an unseen disease. And so people look normal, but they're suffering an immense amount of pain or photophobia or other types of sensory abnormalities that come along with it. And I think that, you know, a lack of understanding of even by doctors often, neurologists too, is a is a common theme with it, with the people that, you know, the veterans that have experienced headache and that we've interviewed that, but also perseverance. I think they're really strong people. They have a really strong sense of service. And that comes through a lot with most of the veterans that we interview. Neil Andrews: Yeah, an unseen disease. I mean, we think we hear that all the time. How there's a lot of stigma directed against people with migraine and headache, an unseen disease. And I would say it's probably especially unseen in men, but most veterans are men and then, of course, there are many women who are veterans, but most veterans are men. And so it's a population that can really help us learn a lot, I think, about the pathophysiology of headache and also treatment, and correct me if I'm wrong, but I think most of the studies like clinical trials that have been done, done on drugs like therapy therapies, primarily these studies are women. So it's a question, will the treatments work as well in men as they do in women? Well, men require different treatments. There's a lot of attention to sex differences now in research. But seems like, you know, and I've heard this said to me that, you know, the VA and veterans, really it's a great pool of people to sort of learn more about migraines and what you guys think about that. Levi Sowers: Yeah, I agree with you. I think there's a large population of veterans that have chronic daily headaches, specifically migraine and or post-traumatic headache that mimics migraine. We're learning more and more that they're probably not as similar as we want them to be, but it's sort of the the symptoms that come along with it - “Post-traumatic headache is more like migraine” or “post-traumatic headache that isn't like that.” But, you know, there's a lot of hope in the future moving forward. We're in a really cool time right now with drug development in migraine. It seems to be a highly targetable disease and, you know, just this week, a paper came out from a group looking at PACAP, which is another neuropeptide that targets that that is showing promise for treatment and it looks like that people who have had PTH or post-traumatic headaches, they are responding to it more. They're more sensitive to it than the normal controls. And that's a really, really cool finding that I think people had hoped for and it seems to have come to fruition. I'm forgetting the author of the paper this week, I just read it quickly. Neil Andrews: Yeah. We're actually going to be doing a news story on that. Levi Sowers: Ah, phenomenal. Neil Andrews: We're excited to see it as well. Yeah. Levi Sowers: Yeah. And there's new drugs being developed targeting PACAP. I'm not going to name the company, but you know, one drug that targets PACAP itself, the neuropeptide, passed phase two clinical trials and that data was shown at International Headache back in September. So it's quite exciting. And you know that that work - some of that preclinical work has been done at Iowa here. We worked on it and it's just really exciting to see these treatments go from the bench to bedside. Neil Andrews: Yeah, You know, it's amazing. So before running the Migraine Science Collaborative, I ran a site called the Pain Research Forum to focus on pain, essentially with Migraine Science Collaborative. We're trying to be a Pain Research Forum for the migraine field. But, since I've been with my science collaborative, you know, learning more about the successes that the migraine field has had with new treatments, especially the CGRP therapies, to me, it's kind of stunning the contrast with pain. I mean, the pain field has not done well in trying to find like alternatives to opioids. And I was always reminded by someone who was a consultant for drug companies and helped us out, you know, as an editorial board member. And he would always mention in his talks that most of the new drugs for pain are really just reformulations of existing drugs or new indications for existing drugs and so, for me, it's just been astonishing to see how well the migraine field is doing compared to pain and also just compared to other, you know, the really hard neurological conditions like Alzheimer's and Parkinson's. So, yeah, it's exciting, as you said. Levi Sowers: Yeah, it's been rather incredible to watch. It's pretty impressive. So watching Dr. Russo go from a hope that preclinical - his preclinical model - would mimic something that happens in humans to being on the patent for one of the four big CGRP drugs that first came out was really cool. Really exciting to watch. It's really neat from a MD perspective to see someone be able to do that, Right? Neil Andrews: Right. Absolutely. Levi Sowers: Doesn't happen every day in science. Could work your whole career and never discover anything that goes to humans. Neil Andrews: Right. That's great. That's great. Levi Sowers: Yeah. Yeah. It's really exciting. I get excited about it anyway. You know, I think that, you know, we as a science community, we being the migraine community and the researchers in it, have really honed in on the translational aspect of the models we have. And I think the pain fields, the more general pain field: neuropathic pain, cancer, bone pain, etc., they lack really good models that have been translational, right? Everybody relies on touch, touch sensitivity, hypersensitivity on dry assay, basically in other reflex based based assays that just haven't translated well to the clinic. And so I think there's a really big push right now by the NIH, for example, to get alternative pain models that may or may not be more translational to humans. I mean, the goal would be to get something more translational and that's you know, we're working on things like that with this facial grimace, Brandon has been really influential with that, to look at facial pain responses in mice as a translational model for humans because humans also grimace and it’s a highly conserved response. Neil Andrews: Yeah. So the question of animal models and how faithfully how closely they mimic or represent what's happening in people, that's always a big question in the pain field and, as you say, the models seem to be doing pretty well in the migraine field headache. And it seems like, from what I understand, it's really- you're never going to have one animal model that replicates everything that happens in humans and that different animal models will be able to tell you about different aspects of headache. Is that is that the correct way of thinking about the models? Brandon Rea: Trying to formulate what I want to say to that. Because I think the answer is yes. Yes. No one model is the end all be all fit for mimicking what we see in humans. I mean, the one end all be all model, that would be people. But we obviously can't do all that work in people. Levi Sowers: You know, I think that building on what Brandon just said, you know, it's interesting to look at different models. Andy Russo really pushed the light sensitivity, so he really focused on the sensory abnormalities that come along with with migraine and tried to reproduce those in mice and other groups like Amino Predominant and came up with a really nice chronic migraine model with using using chronic MTD. And, you know, that's one of the fallbacks for the model that that Andy and I use is that it's an acute and would represent like an acute attack but, you know not to say that episodic migraine isn't debilitating because it is, but chronic migraine patients really have it rough and creating accurate models of that is really important and getting different types of validity for those models, you are exactly correct. And Brandon's exactly correct that not one one model is not representative of all migraine. I think we need to keep that in mind when we when we do our science and make controls and things like that. Neil Andrews: Yeah. And you mentioned grimace, so that that's something that's a pain researcher, Jeff Mogull, has looked at. And as you mentioned, you know, animals do that too. So it's pretty amazing. And so I guess you could call it like a more natural or naturalistic behavior. And so to be able to look at something like that rather than just poking or prodding an animal, that's a good way to sort of find out how they're how they're feeling. I mean, we'll never know how an animal feels, but if you look at something like grimace, that that seems like a pretty good way to approach things. Brandon Rea: And it's really nice for we like to think it's nice for translate ability as well. And it's a reflexive response if you do stuff, you know, on a coffee table, the face you make is pretty reflexive when that happens. But when you are thinking about the clinic and someone is trying to diagnose if they're in pain, how much pain they're in, Grimace can be a method to look at, and it's particularly beneficial with non communicating patients like children or someone who's in severe trauma. But in terms of translatability and if we're going to get asked, “Why are you looking at mice when people get headaches?” Just going from bench to bedside there, that's one of our favorite models that we like to utilize right now. Levi Sowers: I think it's important to also recognize that that that particular assay, while it's thought to be highly translatable, it doesn't represent all types of pain probably. And I think that's something that- it's got a long ways to go. You know, when it came out in 2010 with Jeffrey Mogul and it was amazing. It was really strange to us, actually. We were like, “That can't be real.” And so we started doing it in like 2015/2016 and Brandon and I- Brandon really led the the the push forward in the lab to say, “Hey, look, these mice are squinting after we give them CGRP, something's going on.” And so he suggested we use the grimace model and at first we were kind of resistant, but then we just plowed headlong into it and it works really well. So it's it was pretty cool to see how it developed and changed over time for us. Neil Andrews: Yeah. And I was also curious to ask you about some of the basic science research, whether the research you're doing or others are doing that you're aware of- what seems most promising to you, most interesting to you, that maybe will lead to additional treatments? Is it looking at the brain? Is it looking at other things? What do you think? Levi Sowers: Well, you know, I think right now the while the migraine field is getting so much attention for the CGRP antagonist drugs, it still only treats roughly 50% of them - of patients. And so there's a whole wide open field, especially for basic researchers, to get into and start to understand sort of the nitty gritty of what's going on in the brain. So for our work, we are really interested in the neural circuitry of the central nervous system. You know, there's a huge debate. You see it at AHS and see it at IHC, the American Headache, and you go to these big heady conferences and people have debates. Is it central? Is it peripheral? The answer is probably both to some extent. And I'm really interested in the central nervous system and how it's contributing to migraine like phenotypes in the circuitry behind photophobia, behind such hypersensitivity. And we've made some really good headway with that. And I think, you know, one could sit there and ask, “Well, why is it important that I know that Brain Region X does this?” And, you know, with the development of new brain stimulation methods that are changing every day and getting better and better, you know, there's a hope in the future that if we can identify circuits in the brain that do particular types of things or control photophobia, you know, light sensitivity or control hypersensitivity, that we can begin to manipulate those brain regions in a safe, effective way. There's transcranial magnetic stimulation now - we did an episode on that in our first season or second season, I can't remember exactly. But, you know, people are wanting different treatments. So if you hear about these wonderful, exciting new seizure drugs and you try one and it doesn't work for you, you're just like, “Gosh, like this isn't good, right?” And so there, you know, even with 50% of people treated, migraine is one of the most debilitating diseases in the world. It's second only to chronic low back pain for years lived with disability. So even with 50% of people treated there's still a huge amount- a huge burden on society, especially since it peaks that during your most important years of your life and thirties forties. Neil Andrews: Yeah. And I mean helping one and two people sounds pretty good, but can it be compared to other fields and other drugs that are available for, for people with things like pain? But so many people have migraines that one out of two is not so great. That's leaving a ton of people, you know, without the best treatments. Levi Sowers: Yeah, absolutely. And, you know, I think the other research in the field that that is ongoing or just, you know, really studying these neuropeptides, the other neuropeptides, you know, the PACAP neuropeptide could be really important for post-traumatic headache, you know, with that new paper coming out. So there's a lot of work that needs to be done in animals, to understand how that's working, that we can’t do in humans. And I think, even back to the cellular level, people like Debbie Hay in New Zealand are really understanding the how these proteins interact with the receptors, what they bind to in the body and how those can be utilized to treat migraine and give specificity of these drugs. So, you know, from the most basic of science and pharmacology all the way to the human, there's so much stuff going on that's really exciting. Neil Andrews: Yeah. You know, that actually leads me to another question I have for you. So one of the things I've been struck by working the migraine field compared to the pain field, it seems like there are a lot more basic science papers on the pain field and a lot more basic scientists. So when I was at the Pain Research Forum, we had a weekly literature feature and we had dozens and dozens of basic science papers and we do a similar literature feature every every two weeks in this case. And the number of basic science papers is not anywhere near what it is in the pain field. Wondering if you guys agree with that? Just based on our scan of the literature, and, if it's true, it's all the more amazing that the field has seen success with new treatments. Considering that there isn't as much basic science. Someone once told me that the reason for that may be that the basic scientists and the clinical researchers and clinicians are working together better in the migraine field and how they feel than in other fields. But very curious to see what guys think about that. Brandon Rea: You think it could be that the pain field is a wider net, wider umbrella versus more specialized migraine where pain is the prime. The primary symptom is one of many symptoms, right? So maybe just by sheer numbers or types of pain pills have to be a bit expensive. But that being said, we worked with and talked to a number of clinicians and collaboration seems to be pretty key and works pretty well so that you could be on to something there. Levi Sowers: But yeah, you know, in my opinion there is not a lot of migraine basic scientists out there, probably a handful of labs in the world, but it's growing and it's getting a lot better. You know, there's several Danish groups that are really phenomenal. And there's more and more labs popping up in the United States and, you know, the bastions of the fields, the Andrew Charleses, the Ashinas, the Rami Bursteins - you know, Ashina doesn't do a whole lot of basic science, but he's part of the Danish headache group that does a lot of basic science. And, you know, they have some really influential PACAP work and so does Andy Russo and- you know, but the people moving in to replace them are- it's just not growing as fast as I would love to see. I'd love to see many, many more people. You know, there's some really good groups down in Texas, too - Greg Dussor - and so I think that we need more people to do basic science in migraine. But I agree with Brandon and I think that, you know, there's so many different types of pain and everybody has their little niche that they study, whether it be ion channels or pathways or or immune interactions. There's just so many different things to study about pain. And I think migraine is this really weird, complex multi-sensory disease that happens to be defined by pain. Right? And so it's interesting. It's a really interesting disease that I have grown to really love to research and there's making huge progress. It's sort of serendipitous, to be quite honest with you. Neil Andrews: Right, yeah, and a lot of, you know, we cover some of the pain research because it's very relevant to migraine and also a lot of the pain papers do include migraine patients. So we you know, maybe it is a little bit broader than I think there's a lot of the pain papers do include my brain clinical populations and again even if they don't, a lot of what the research covers is relevant to migraine like one example would be, you know, this idea that we mentioned earlier, migraine stigma, that's a problem in the pain field per se as well and it's relevant to migraine so- Levi Sowers: Yeah, yeah, absolutely. Good discussion. Neil Andrews: I'm sorry, I- just one more question I have for you guy. How do you think we get more people to do basic science at the Science Collaborative? We're trying to do some things to help with that. But what do you think? How do we get more people doing animal and cell research in the migraine and headache field? Levi Sowers: Good question. I think that, in my opinion, more support for new scientists in the field is really warranted. Not even necessarily warranted, I think they're doing a pretty decent job of it, actually. But getting people interested in migraine, you know, the more science labs you have, the more people that are going to train in them and become interested in migraine. Right? I don't think it's a necessarily an easy thing to study- it is complex. There's a lot of different behavioral studies for us that we do, for example, and, you know, getting the focus more on “what are the benefits of studying migraine?” and the NIH is doing a really good job of that. If you go to any of these large headache meetings, you know, the National Institute of Neurological Diseases - the NINDS and one of their program officers who oversees a batch of grants that study headache is always there talking to us about how to get involved and they're really pushing migraine as something that we should study and trying to get people into it. So I think that's been a really good thing and I know that the grant funding has gone up significantly over the past decade. So it's improving and people are getting more involved and you just have to recruit people and treat them well and get them into science, get them into migraine science. Neil Andrews: Right. Great. Levi Sowers: All right. Can I ask you some questions now? Neil Andrews: Yeah, absolutely. Levi Sowers: All right, Neil. So, you know, I've always found it really interesting that people choose science journalism as a career. So how did you get involved with that? What is your life story to get to here today interviewing Brandon and I? Neil Andrews: Yeah, no, that's a great question. Probably most people don't, you know, from the age of five said yes, one day I want to be a science journalist, but- so I always thought I was going to be a doctor. My father was a doctor, he was an anesthesiologist. And so from the background that I come from, it's kind of - I don’t want to say it was expected of me…maybe it was expected that you might choose medicine, but I just decided it wasn't for me. I knew- I studied neuroscience as an undergrad and I knew research wasn't for me. And one example of this would be, I was doing my senior thesis using the microtome, which is this, as you know, this machine that has a very sharp blade that allows you to slice brain tissue and one day I was in there and I lost focus for a second and I kind of just sliced my thumb. I would say, I'm sorry, this is too much information for everybody. Levi Sowers: I’ve done this as well, I had to go to the E.R. once. Neil Andrews: I had to go to the E.R. too. Brandon Rea: And it cuts so cleanly too, it’s just like, “Oh no…”, that mild moment of panic. Neil Andrews: Yes! I was so embarrassed by it as as there are drops of blood dripping on the lab floor that I was trying to clean it up before I told my professor about this. But he took me to the emergency room, and I remember a very calm E.R. doctor just gave me some stitches. So maybe a career in research wasn't for me. And, to be honest, I do not like rodents. It's one of the reasons I have a cat. So I had to figure out what was I going to do. But I love neuroscience, again, I mentioned my majored in it in college and I always love to write and I found out that you could combine the two. There actually were a handful of programs at the time specifically focused on science journalism or medical journalism. So my program was at Boston University, it was a graduate program, a Master's degree program. And it was in that sort of the College of Communication in the journalism school, but it was its own specific program training us how to specifically report about science and medicine, because I think there are some, you know, unique challenges and things that go along with that compared to reporting on whatever else, politics or business. So, yeah, it's just a great way for me to combine interests in neuroscience and writing. It's great to be able to report and to talk to researchers like yourselves, really interesting people, and there's always a new study that comes along that's really interesting and you're always learning. And it's been a great career for me, and I feel lucky that I've been able to cover neuroscience, pain neuroscience and now migraine neuroscience since that was, you know, it's always been my first love in terms of learning about the science. Levi Sowers: Do you find it difficult to communicate these papers or these studies to a general audience? Neil Andrews: Yeah. So I would say the the basic science papers, that's where the challenge is. So, you know, I met at the beginning like a target audience is researchers and clinicians. But again, we try and cover stuff so that it will appeal to more people who really want more knowledge. And it's much easier to do that with the clinical papers. The basic science is very, very challenging to do and there are some sometimes we've been very successful at it, you know, sometimes there are basic science papers that are so involved that we decided, you know what, this is…it's going to be too much. So occasionally that happens. But the challenge is really with the basic science and, you know, the methods are different. Things are, you know, people are not going to be familiar with. People will be familiar with, like, a clinical trial. “They gave people a drug and they compared it to people who got a placebo”, people are aware of that but electrophysiology and all these different fancy-schmancy techniques that you guys use as basic scientists- that's part of the challenge, I think, in covering basic science. But with my writers, there are certain things that you can do with the writing aspect. So shorter paragraphs as opposed to longer ones breaking up long sections into shorter sections using headings. There are things like that that you can do to help get the word out to a more general audience. Levi Sowers: Nice! So, you know, one thing that I think is funny is that we, as scientists, worry about communicating to the general audience all the time, but I worry about listening to Electrophysiologists talk about their work too. [Laughter] Levi Sowers: It’s just- like, Brandon's learning computer coding right now, and he talks to me about it and I'm just like, “Why are you speaking in tongues to me?” Brandon Rea: Yeah, I’ve found smiling and nodding goes a long way. [Laughter] Neil Andrews: You know, I have to say, like, if we're talking about basic science papers, a basic science paper, we will often sort of say a number of electrophysiological specimens showed X, Y and Z. So we just sort of state the main result rather than getting into all the nitty-gitty action potentials, voltage, and all that sort of thing. Levi Sowers: So I think, you know, coming away with it as a science, you know, I have to write science in my papers and it's difficult to because you have to have enough technicalities to get it through reviewers. But at the same time, you want someone to be able to know - what's the big takeaway, right? What is the big takeaway in this? And I think that's what is so important about your field, is that you guys distill down what we do as basic scientists and the jargon we use and really distill it down into something that is manageable and understandable for the general audience. And I think that science journalism is a really key thing for scientists. It really is important and the work that you guys do is really cool. Brandon Rea: Yeah, make it understandable and tell us why we should care - those two big things. Neil Andrews: Yeah. No, absolutely. And so when I was at pain research, I ran a science journalism training program for younger researchers. And one of the things that I that I tell them is that your training, it's basically the opposite of what you need for clear communication to a more general audience in a host of ways, both in terms of sort of just sort of like nitty gritty writing issues like using science - the language of science usually is passive voice. You're trying to get the person out of it, but good journalism puts the person into it. Use active voice. You want to hear human emotion from your sources, the researchers that you're talking to. I had. How did you react to this finding? Were you surprised? Were you excited? Is this what you expected? Is it not what you expected? So the writing style, things like that, taking yourself out of it, also putting the message upfront. Right. I know you have an abstract in the scientific paper, but usually sort of you don't get the message of why it's important till the end, whereas in journalism you want to put that at the beginning. So yeah, so it's, it's challenging, but I think that there's a need for, for good science journalism. But I hope more scientists will do science journalism because of the knowledge and the more people doing it, the merrier. It doesn't only have to be science. Journalists of scientists get training in it. It's a great thing. Levi Sowers: Awesome. All right. I have a couple of odd questions for you. So first one is, what is the coolest thing you've ever learned about, in your mind, migraine since you started working? Neil Andrews: Right. I would say that how complicated it is. How it's not just one condition. You know, two people can have the same diagnosis- migraine. But what's going on in a person can differ a lot from what's going on in another person in terms of what's driving it. So, you know, we were talking about treatments earlier. CGRP treatments work well in some people which would tell me, like CGRP may be an important factor in terms of what's driving it in that person who responds to CGRP treatments. But for other people who don't respond, maybe other molecules, other things are more important. So just the fact that it is so complex differs so much from one individual to another and that it affects so many different symptoms. And as it's always said, migraine is more than just a headache. That's the fact that, you know, people might have an aura or visual disturbances, other things like, you know, nausea, fatigue and mood changes. It just involves so many different systems. And it's a complexity that makes it harder to unravel maybe but, from my perspective, that makes it really interesting to write about. So I'd say that's one of the things. And also, as I mentioned earlier, just I marvel at how the field has done well with new treatments. So that's something that struck me as well. Levi Sowers: We're coming to an end here, by the way. Okay. This is the last question that we asked all of our people that we interview. Brandon Rea: So aside from scientific writing, what are your hobbies? What do you like to do for fun outside of work? Neil Andrews: Well, how much time do we have? [Laughter] Brandon Rea: And, you know, you can regale us, go ahead. Neil Andrews: All right. I'll give you a few things. So I love rock concerts, actually. And my favorite band, maybe this dates me, but my favorite band is U2. And I actually just got back from Las Vegas. They're doing a residency there with this new structure sphere, which is this incredible new venue with tons of video screens and so it's as much a visual experience as an auditory one. But I love going to rock concerts. And so that's one thing I do. I live in New York City, so there's no shortage of that. Another hobby is coffee. I love coffee and I actually, on my website, my professional website, I have a page, a coffee page. So what I do is, I go to independent coffee places in New York City and I rank the coffee. The latte is my drink, so I rank in under 1 to 5 scale. You can see this on my website. I've gone to over 100 places so far ranking the coffee, and there's so much good coffee in New York City. I feel like no one should have a subpar coffee experience. So that's why I rate it. When I originally started this hobby of mine, I didn't rate the places that weren't very good. I just wanted to be positive. But I was like, Know what? Because there's so much good coffee here, no one should ever have to suffer with bad coffee. So coffee is a huge interest of mine in Iceland. Brandon Rea: How many shops have you gone to in one day? Neil Andrews: You know, the most I go to in one day is three. Three becomes a little unmanageable. I think two is better. At first I started with one. I felt like maybe it would bias me in some way to do two because generally for me, one latte is enough. But in order to go through enough places, I started to do two. Yeah, I think three is a little too much. And then there are just a ton of other things I love to read. So I love books. I love, as I mentioned, music, movies. I could go on, but coffee and rock concerts stand out to me. Brandon Rea: Yeah. There you go. Levi Sowers: Great answer. One of the better ones. [Laughter] Levi Sowers: We've had some good ones, but that was a good one. Well, hey, thanks for coming on. Thanks for agreeing to do this with us. It was cool to hear your questions to us. I really like that. And being able to answer some of those I think is really fun. So, yeah, this will be, as I said, this will be on the Migraine Science Collaborative website as well as the Vets First Podcast website eventually. So thank you, Neil. I really appreciate your time and reaching out to us about this possibility. Neil Andrews: Yeah, No, thank you so much. It's been a lot of fun. Thank you so much for having me. It's been a fun discussion and hopefully we can do it again sometime in the future. Announcer: This concludes today's Vets First Podcast. For questions or comments relating to the program, please direct email correspondence to [email protected]. Thanks for listening!