Alumni Profile: Philip Bain, MD '85

The year was 1993 - a pivotal point in the career of Philip Bain, a 1985 graduate of the University of Wisconsin School of Medicine and Public Heath in Madison. It was the year he began thinking seriously about headaches.

 

Following medical school, Bain completed his residency in internal medicine at the Medical College of Wisconsin (MCW). He was one of the first residents in MCW's primary care track for internal medicine.

 

During the next three years, he worked in primary care at a multi-specialty group practice in West Bend, Wisconsin, and then moved to a small office in Hartland, not that far from his hometown of Lake Geneva.

 

After obtaining an added qualification certificate in geriatrics in 1992, Bain wanted to diversify his clinical practice as he looked to the future.

 

"I asked myself: What group of patients do doctors generally shy away from in primary care?" he says. "Since I had moved to a new area, I thought this would help me build a practice. I also wanted a field where active research was occurring, and where there was a great need to help the younger part of my practice."

 

He decided that he wanted to learn more about the treatment of patients with headaches, so he arranged a visit to the Cleveland Clinic Headache Unit. It was there that he began to understand the significant impact headaches can have on people.

 

Headaches have been a strong interest of his ever since. In the intervening 17 years, Bain has watched the science underlying headaches change dramatically and has written three books on the subject.

 

Coincidentally, 1993 was also a milestone year in the history of headache treatment. That's the year the medication Imitrex came on the market. The drug has revolutionized the treatment of patients with migraines.

 

"Last year, in conjunction with the 50th anniversary of the American Headache Society, members voted that the introduction of Imitrex has been the single most important event in the field of headache care in the past 50 years," says Bain.

 

From Neurosis to Biologically Based Disorder

 

While headaches have been reported since Babylonian times, even today they often are under-diagnosed and misunderstood. But for those who have headaches, the suffering is real indeed.

 

Migraines are the most common, and most debilitating, of headaches, affecting more than 28 million people in the United States.

 

"More people are afflicted with migraines than with asthma and diabetes combined," Bain says. "About 18 percent of adult women suffer from migraines - that's one in six women!"

 

In the past, migraines were commonly ascribed to hysterical, hypochondriacal women. But as science caught up with the field, the causes of migraines and other headaches were gradually sorted out, validating headache sufferers' complaints and moving headaches from a neurosis to a biologically based disorder.

 

Currently, clinicians think that when a genetically prone individual comes in contact with a specific trigger, identifiable or not, a cascade of events begins in the back of the brain, Bain says.

 

"The nerves in the back of the head are part of the visual cortex," he explains. "When these nerves are activated, events thought to be related to the visual aura symptoms reported by a significant minority of migraine sufferers occur."

 

When these nerves in the back of the brain are stimulated, a wave of additional nerve activity slowly moves forward. The ends of the nerves located near blood vessels release chemicals that dilate the arteries and lead to inflammation.

 

"As the process continues to spin out of control, the forward-moving nerve activity stimulates nerves in the neck," he says. "These nerves then stimulate nerves in the brain's nausea and pain centers, leading to a full-blown migraine."

 

The mysteries of migraine have unfolded over the years Bain has focused on headaches and attended national headache scientific meetings.

 

"It's been a fascinating journey. It seems like every year, science gives us a few more pieces to the migraine puzzle," he says. "Sooner or later, we will figure it all out."

 

Despite the success of Imitrex, however, Bain has learned that the effective treatment of headaches is not focused only on medications. He encourages patients to make healthy lifestyle choices that can bring relief from headaches.

 

"Patients need to learn what triggers their headaches - which foods, beverages or alcohol," he says. "And they need to understand that they require restorative sleep, and shouldn't skip meals."

 

Unfortunately, he says, many people don't want to do the hard work.

 

Physician Also is an Accomplished Author

 

Bain has authored two books on headaches and is currently working on a third with Dawn A. Marcus, MD, a neurologist at the University of Pittsburgh. Their first, published last year, was "Effective Migraine Treatment in Pregnant and Lactating Women: A Practical Guide."

 

Their second book, "The Woman's Migraine Toolkit: Managing Your Headaches from Puberty to Menopause," should hit the shelves in the next few months.

 

Aimed more at women headache sufferers than practitioners, this book covers topics such as alternative approaches to treating migraines, headaches' relationship to hormonal levels, the role of exercise and how to get more out of doctor visits.

 

Bain's third book, "Treatment of Headaches in the ER and Urgent Care," will be released in April 2011. It aims to fill an important gap, alleviating the frustration patients, emergency department personnel and insurance companies often feel around headaches.

 

"ER physicians generally haven't had extensive training in headache care, and headache patients presenting to the ER often are desperate for help," Bain says. "The book tries to outline a useful strategy that should be welcomed by all involved."

 

After practicing in Hartland for many years, Bain and his family moved back to Madison in 2006. He and wife Carole Bain, MD '86, MPH, have three children: Ben, a senior at UW-Madison, Eric, a freshman at the University of British Columbia, and Eryn, a student at Madison West High School.

 

Bain joined the Dean Clinic and currently is the site chief in internal medicine at the East Clinic.

 

The Bains love taking part in Madison activities such as Concerts on the Square. And Bain likes the fact that he can ride his bicycle all over town, even the 22-mile trip to work and back when weather permits.

 

During his leisure time, he enjoys reading, especially about human behavior and why people make the choices they do.

 

Books such as "Nudge, Improving Decisions about Health, Wealth and Happiness" and "Predictably Irrational: The Hidden Forces that Shape our Decisions" are two recent favorites.

 

"How people decide what to do spills over into medicine, especially involving areas such as medication compliance and shared decision making," he says.

 

In June, Bain traveled to Honduras with his son to participate in Global Medical Brigades, which provides medical services to people in need. During the week, Eric helped in triage and shepherded waiting patients to see his father and the other doctors. The physicians saw some 300 patients each day for three days.

 

"Disabling headaches were one of the top 10 reasons patients traveled long distances to the clinic to see a doctor," Bain says. "It was fascinating to see that some of the very same problems faced by patients in Madison were also experienced by people half a world away."

 

By Sharyn Alden

This article appears in the fall 2010 issue of Quarterly.

Date Published: 11/08/2010