Marcia Wilkinson was a consultant neurologist at Hackney Hospital and the Elizabeth Garrett Anderson Hospital, London, and medical director of the City of London Migraine Clinic. She was born Marcia Harvey in Sheffield, South Yorkshire, the second of three daughters born to Cosmo George St Clair Harvey, a colonel in the Royal Artillery, and Constance Armine Harvey née Sandford. Following her education at Wycombe Abbey, where she was head of school, she went up to Somerville College, Oxford, to read medicine. She found time away from her studies to gain blues for tennis and lacrosse, and a half blue for squash.
She was a house physician on the medical unit at the Radcliffe Infirmary in Oxford, and then worked for Russell Brain [Munk’s Roll, Vol.VI, p.60] at Maida Vale Hospital. Brain was a strong influence in Marcia’s career as a neurologist. Her first publication, in 1947, was a landmark paper on the surgical release of carpal tunnel syndrome, co-authored with Brain (‘Spontaneous compression of both median nerves in the carpal tunnel; six cases treated surgically.’ Lancet. 1947 Mar 8;1[6443-6445]:277-82).
By 1949 she was a full-time Nuffield Foundation research fellow at the Bernhard Baron Pathological Institute at the London Hospital, where she studied the morbid anatomy of 17 cases of cervical myelopathy associated with degenerative changes. As she found no evidence of inflammation, Marcia favoured the term cervical spondylosis. She pursued this subject for her DM, submitted in 1959. Further papers and books followed, published jointly with Russell Brain.
Her first consultant post, in 1953, was at the Elizabeth Garrett Anderson Hospital in London, where she worked until 1984. Further posts followed in 1954, at the South London Hospital and St Margaret’s Hospital, Epping, and Hackney Hospital in 1957.
In 1963 Marcia set up the regional neurological unit at the Eastern Hospital, Hackney, a rehabilitation unit for the young disabled, many with severe head injuries from motorbike accidents. Her approach was radically different from other units since patients remained in the unit for as long as they continued to improve. This meant an average length of stay of around five months – at least three times longer than most units. Her reasoning was that optimum conditions could enable maximum recovery and so the duration of stay was set by the patients’ progress. It paid off, since over 80% of the survivors were able to return home rather than spend the rest of their lives in care.
But her real passion was migraine, a condition of personal interest, and in October 1963 she set up a migraine clinic at the Elizabeth Garrett Anderson Hospital. Her approach to the management of migraine was heavily influenced by Elizabeth Garrett Anderson’s doctoral thesis, presented in 1870, which she translated into English from the original French. Simple but fundamental principles were the importance of nutrition, regular meals, regular habits and the treatment of the attack with effective medication supplemented with sweet tea and rest.
In 1970 she was appointed medical director of an innovative new clinic in the City of London, which was open during working hours so that anyone developing a headache while at work could access the clinic for treatment while at work. The City Migraine Clinic was the result of collaboration between the British Migraine Association, a patient organisation, and the Migraine Trust, a medical group first chaired by Russell Brain. Based in Bartholomew Close, near St Bartholomew’s Hospital, it was the first centre in the world to see patients with acute migraine and provided a unique opportunity to assess and manage patients during attacks. It was very important that the building had a kitchen. Why? In Marcia’s words: ‘For two reasons: first because the staff could not go out at lunch-time as that was the time that most migraine sufferers came in with their headache and secondly because…hot sweet tea was an essential part of the treatment.’ The Clinic also provided ample opportunity to advance research. This included the discovery that absorption of analgesics was delayed during migraine because of gastric stasis, which could be effectively reversed by the addition of metoclopramide.
The Clinic initially encountered some scepticism from international colleagues, but the successful results spoke for themselves, with the need to move to larger premises in Charterhouse Square. It was not long before the Clinic became an international model, with similar clinics being set up around the world.
When the Migraine Trust moved the Clinic to Charing Cross Hospital, Marcia contacted her colleague Joseph Norman (‘Nat’) Blau [Munk’s Roll, Vol.XII, web], who also had a professional and personal interest in migraine, and requested his support to keep the Charterhouse Square clinic open. With financial support from the British Migraine Association and donations from the City, the City of London Migraine Clinic opened in 1980 as an independent medical charity. Marcia headed up the research, while Nat was the driving force behind the fundraising. Research flourished, with a wide range of industry sponsored trials, including many of which are now standard migraine treatments, as well as independent projects. Marcia identified that over frequent use of symptomatic treatment could result in more frequent headaches, now widely recognised as medication overuse headache.
Marcia had a significant international reputation and was one of the first British members of the American Association for the Study of Headache (now the American Headache Society). She was a founding member of the International Headache Society and president from 1985 to 1987, before taking over as editor in chief of the Society’s journal, Cephalalgia. She was elected an honorary life member of the Society in 1997. She was an honorary fellow of the American Neurological Association and an honorary member of the Scandinavian Migraine Society, the British Association for the Study of Headache, as well as the Anglo Dutch Migraine Association, which has created an annual lecture in her name.
She received numerous awards, but perhaps the most germane accolade was to be honoured in 2000 with the first Elizabeth Garrett Anderson award for her extraordinary contribution to relieving the burden of those affected by headache.
Away from medicine, Marcia spent many a holiday travelling with her lifelong friend Anne Bolton, wife of Valentine Logue [Munk’s Roll, Vol.XI, p.343], including trips to Russia, Darjeeling, Nepal and the Falkland Islands. In the late 1980s, during a trip along the Silk Road and the Karakoram Highway, she and Anne were troubled to learn that many women were dying in childbirth because male doctors were not allowed to examine women. Hence followed a letter to the Aga Khan demanding that something be done. Several exchanges of correspondence followed and their persistence paid off: although not able to take up the Aga Khan’s suggestion that they might take on the role themselves, they persuaded him to cover the costs of training and the ongoing support of a female doctor for the region.
She retired in 1999, which gave her more time to spend on her hobbies, extend her late father’s collection of rare stamps, and continue her travels around the world.
Marcia married Anthony Wilkinson in 1944, but within a few weeks she was widowed when he was killed in action. She married Louis Sefton in 1952, with whom she had two daughters, but was widowed four years later. She was survived by her daughters, Ottilie and Armine, both highly successful women in their careers of law and medicine respectively, and five grandchildren.
Anne MacGregor
[The Migraine Trust 18 February 2013 Obituary – Dr Marcia Wilkinson www.migrainetrust.org/news-obituary-dr-marcia-wilkinson-16585 – accessed 11 January 2016; Cephalalgia. 2013 Aug;33[11]:951-3 http://cep.sagepub.com/content/33/11/951 – accessed 11 January 2016; BMJ 2013 346 1349 www.bmj.com/content/346/bmj.f1349 – accessed 11 January 2016]