2024-12-31-accounts - International Headache Society

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

Trustees

The Trustees, who act as directors of the company, who have served since 1 January 2024, are as follows:

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F Ahmed (Honorary Treasurer) L Mechtler
A Antreou A Özge
S Ashina P Pozo Rosich (Honorary Secretary)
R Burstein (President) M F Prieto Peres (President-elect)
A Carmine Belin C Tassorelli (Past-President)
O Daniel M Valença
J Hoffmann (resigned 1 May 2024) M K Velez
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Trustees benefit from indemnity insurance to cover the liability of the Trustees which by virtue of any rule of law would otherwise attach to them in respect of any negligence, default or breach of trust or breach of duty of which they may be guilty in relation to the Charity. The cost of this insurance in the year has been included within total insurance costs.

Structure, governance and management

In common with all limited liability companies, the Society has a board of directors who take overall responsibility. A new Memorandum and Articles of Association was adopted in September 2008 which created a Board of Trustees, who became the directors of the Society.

The day-to-day running of the Society is the responsibility of the Board of Trustees with the assistance of a selfemployed Executive Director (until August 2024), a self-employed Administrative Manager, and outsourced financial services support from MHA. In addition, there are 16 advisory Standing Committees and Special Interest Groups.

The constitution allows for the members in general meeting to elect Honorary life members; seven were elected in 1997 (Eero Hokkanen, James W Lance (since deceased), Frank Clifford Rose (since deceased), Federigo Sicuteri (since deceased), Ottar Sjaastad (since deceased), Dieter Soyka (since deceased), Marcia Wilkinson (since deceased)) and a further four in 2002 (John Desmond Carroll (since deceased), Karl Ekbom (since deceased), Lee Kudrow, Edgard Rafaelli Jnr (since deceased)). From 2005, it was agreed that all PastPresidents of the Society should be elected as Honorary life members following their leaving the Board of Trustees (including retrospectively) and a further seven were elected at this time (Marie-Germaine Bousser, Michel D Ferrari, Ninan T Mathew (since deceased), Jes Olesen, Jean Schoenen, Peer Tfelt-Hansen, K Michael Welch). In 2009 a further two Past-Presidents (Michael A Moskowitz, Fumihiko Sakai) and two recipients of the IHS Recognition for Service Award (Peter J Goadsby, Timothy J Steiner) were elected. In 2011 the Past-President (Hans-Christoph Diener) and a recipient of the IHS Recognition for Service Award (E Anne MacGregor) were elected. In 2013 two recipients of the IHS Recognition for Service Award (Giuseppe Nappi, K Ravishankar) were elected. In 2017 the Past-President (Alan Rapoport) was elected. In 2019 the Past-President (David Dodick) was elected. In 2021 the Past-President (Lars Edvinsson), two recipients of the IHS Recognition for Service Award (Allan Purdy, Vincenzo Guidetti) and two Honorary Life Members (Patrick Humphrey, Pramod Saxena) were elected. In 2023 the Past-President (Messoud Ashina) and two Honorary Life Members (Rigmor Jensen, Stephen Silberstein) were elected.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

IHS offers Junior membership at a reduced rate to Residents and Trainees alternatively within three years of obtaining medical doctorate or academic post graduate degree or specialist certification, whichever was obtained latest, up to 15 years following MD qualification, or within six years of obtaining latest academic degree for other academic groups, up to 15 years following primary qualification. IHS offers membership at a reduced rate to Allied Healthcare Professionals. IHS also offers membership at a reduced rate to eligible members from upper-middle income countries. Standard members (which includes Honorary, Junior, Allied and Upper-middle income country members) are entitled to vote at IHS member meetings.

National scientific societies sharing the aims of the IHS can become Affiliate Member Societies of IHS. The representatives of the Affiliate Member Societies join the Advisory Council.

IHS offers free of charge Associate membership to assist those professionally interested in headache disorders who are residents of low- and lower-middle income countries. Associate membership is also offered to those eligible for junior membership from upper-middle income countries.

Induction and training of Trustees

Following elections at the Annual General Meeting, a ‘Trustees’ Pack’ is given to new Trustees which includes the Society’s Articles and Bylaws as well as Charity Commission Guides on being a Trustee of a UK registered charity. In view of the worldwide location of Trustees it is complex to organise formal face to face training for new Trustees.

Risk management

In June 2004 the Society adopted a formal risk management policy and structure for assessing risk and this was updated in January 2012. The Society supports a systematic approach to risk management that ensures that the risks associated with every activity are assessed, ranked and prioritised. A risk map is produced which is reviewed by the Board of Trustees annually. The Board of Trustees is confident that this ensures that any exposure to risk is identified and that procedures are in place to manage that risk.

The Trustees consider the principal risks and associated mitigation strategies to be:

The loss of key staff – the Society implements succession planning including overlapping terms of Board members to minimise knowledge loss in these circumstances
Conflicts of interest – the Society has a clear policy on disclosure of conflicts of interest and procedures in place to ensure that decisions are not influenced by individuals with associated conflicts
Compliance with legislation and regulations – the Society allocates key compliance procedures across the Board of Trustees to ensure compliance is adhered to as required
Dependence on income sources – the Society retains adequate reserves to cover potential shortfalls in funding.

Public Benefit

The Trustees confirm that they have referred to the information contained in the Charity Commission’s general guidance on public benefit when reviewing the Society’s aims and objectives, and in planning activities and strategy for the year ahead.

Through its activities, most notably the journals, the International Congress, the International Classification of Headache Disorders, clinical trial guidelines, worldwide education and the Online Learning and Education Centre, the Society disseminates vital research and educates physicians and headache specialists throughout the world in order that they are better able to understand and treat headache sufferers.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

Objectives and Principal Activities

The Society’s activities, summarised below, ensure that it fulfils its charitable purpose and that they are for the public benefit across the world.

Objectives

The objects are to relieve sickness and to protect and preserve health in the United Kingdom and elsewhere in the world, including in any one or more of the individual countries of the world. The Society achieves this, in particular, by promoting research into the causes, mechanisms, consequences, diagnosis, prevention, treatment and other aspects of headache and by disseminating the useful results of such research, by advancing the education and raising the awareness of the public of the subjects of headache, its science and management, and by such other ways as the charity through its trustees may from time to time decide.

The income and property of the Society are applied solely towards the promotion of its objects.

Aims and Activities

In 2024 the Society aimed to continue its work in promoting headache research and dissemination of knowledge.

The 2nd Regional Headache Conference (IHS 2024 | Science) was held in Berlin, Germany, in May. An International Headache Academy (iHEAD) was held in Berlin prior to IHS 2024 | Science. The Online Learning and Education Centre on the website was updated with new online educational content and a second online learning institute course was added. Headache awareness campaigns were run on IHS social media channels and the website on cluster headache, trigeminal neuralgia, World Headache Awareness Week, and Migraine Awareness Day. Six Headache Trainee Programmes, 10 Short-stay Scholarships, and three Junior Research Grants were awarded. A Visiting Professor programme was held in the Philippines. A joint session was held at the World Congress of Pain (International Association for the Study of Pain [IASP]). Work was initiated in the lower-middle income country (LMIC) initiative - Access to Headache Care in LMIC, a project to ensure access to medications in LMIC countries and education of healthcare professionals in the diagnosis and treatment of headache.

Global practice recommendation on treatment and prevention of migraine and guidelines for controlled trials of pharmacological preventive treatment for persistent post-traumatic headache attributed to mild traumatic brain injury were developed. Migraine treatment guidelines in collaboration with the Italian Headache Society, and guidelines on real-world data studies in headache are ongoing with expected publication in 2025. All IHS guidelines are published in Cephalalgia. Work began on the International Classification of Headache Disorders 4th edition (ICHD-4) and an editorial was published in February 2024.

Cephalalgia and Cephalalgia Reports, the IHS scientific journals, continued publication. Cephalalgia continued its transition from a subscription journal to an open-access title to ensure that scientific research is freely available and enable researchers with limited access or funds to access the most up to date advances in the field of headache research and medicine. Two IHS Corporate Roundtable meetings were held and brought together key stakeholders to ensure the future of headache medicine and patient access to new medications.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

Activities

Every other year the Society, through its subsidiary company, holds an International Headache Congress, at which developments and research in the field of headache is discussed. In 2022 the first Regional Headache Conference was held, also through the subsidiary company, and in 2024 a second Regional Headache Conference was held. The Society also publishes a professionally acclaimed journal, Cephalalgia, a companion title, Cephalalgia Reports, and hosts an extensive Online Learning and Education Centre on the IHS website. Educating the next generation of headache specialists (iHEAD) and teaching in regions where headache specialists are few (Visiting Professor programme, IHS Master Schools, IHS Regional Outreach ProgrammE) are key objectives, as is raising awareness of headache and migraine worldwide and reducing the associated stigma.

Professional Collaborations

The Society works closely with its Affiliate Member Societies (national societies). In 2024 there were 58 Affiliate Member Societies worldwide. Some of the Affiliate Member Societies offer membership of IHS through their society; these include:

the American Headache Society
the Australian and New Zealand Headache Society
the Brazilian Headache Society
the British Association for the Study of Headache
the Danish Headache Society
the Dutch Headache Society
the French Headache Society
the German Migraine and Headache Society
the Italian Headache Society
the Italian Neurological Association for Research on Headache
the Japanese Headache Society
the Korean Headache Society
the Portuguese Headache Society.

IHS (via the IHS Trading Company) hosts the biennial International Headache Congress (IHC) which is organised in consultation with the national society of the hosting country. Recent congresses have been held in Seoul, Republic of Korea (2023), virtually – joint congress with the European Headache Federation (2021), Dublin, Ireland (2019), Vancouver, Canada (2017), Valencia, Spain (2015), Boston, USA (2013), and Berlin, Germany (2011). IHS has also organised Regional Headache Conferences in non-IHC years, in 2022 Buenos Aires, and 2024 Berlin.

The next IHC will be in São Paolo, Brazil, in 2025.

IHS also collaborates with the World Health Organization on the International Classification of Headache Disorders (ICD-11) and the List of Essential Medicines, with IASP and the World Federation of Neurology, and with the European World Organization of Family Doctors (WONCA) on education of primary care physicians. IHS is a member of OneNeurology.

Fundraising

The Society carries out its fundraising both internally and externally. It does not use professional fundraisers or commercial participators.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

Corporate sponsorships provide the only fundraising income for the Society and this is done through Trustee interactions with corporate companies who are contacted in the course of a regular professional relationship or though the Professional Conference Organiser in respect of the IHCs. The Society is not subject to any undertaking to be bound by any voluntary scheme for regulating fundraising or any voluntary standard of fundraising in respect of its activities.

The Society does not raise funds from the public. No complaints have been received in respect of the Society’s fundraising activities during the financial year.

Strategic Report

Achievements and performance

Dr Patricia Pozo Rosich reports to the Society as honorary secretary.

This report covers the activities of IHS for the year ended 31 December 2024.

In January 2023 Cephalalgia switched to an open-access title, enabling published scientific research in Cephalalgia to be freely available and remove barriers to ensure clinicians and researchers with limited access or funds can keep up to date with advances and developments in the field of headache research and medicine. It is also beneficial to authors who receive higher exposure for their research. As expected with the switch to open access the impact factor and journal ranking initially decreased, but increased with the 2023 impact factor being 5.0. The journal is still in a transition period but has remained scientifically strong publishing over 130 articles in 2024. Cephalalgia is ranked 32 of 277 clinical neurology journals, and 49 of 310 neuroscience journals. Simona Sacco continues as Editor-in-Chief having taken over the position in January 2023; Wendy Krank continues as Managing Editor and the journal is published by SAGE Publications Ltd.

Several special collections and guideline and other IHS papers were published in Cephalalgia during 2024:

Two Global practice recommendations for acute and preventive treatment of migraine
Guidelines for controlled trials of pharmacological preventive treatment for persistent post-traumatic headache attributed to mild traumatic brain injury
Advancing gender medicine in migraine to bridge the gap in men (special collection)
Worldwide availability of medications for migraine and tension-type headache: A survey of the International Headache Society

Work continues on the International Classification of Headache Disorders, 4th edition; an editorial was published and the Committee members met again in September 2024.

The journal is increasing its social media presence with the appointment of two social media editors and the introduction of graphical abstracts. An Editor’s Choice page has been added to the IHS website with a monthly article, selected by the Editor-in-Chief, highlighted, and an interview held with the lead authors. A Reviewer’s Academy was created to nurture young researchers and physicians in the field and give them the skills to successfully peer review articles.

Cephalalgia Reports, the open-access silhouette title to Cephalalgia providing an international forum for original research papers, review articles, clinical perspectives, case reports, technical reports and short communications now has over 160 published articles. The journal is listed in the Directory of Open Access Journals and Scopus and will apply for PubMed listing.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

Membership numbers have been increasing over the past years, and although the record numbers in 2023 were not achieved numbers were still positive with over 1,800 members for the year, in 2024 IHS welcomed over 200 new members. There was an increase in membership fees in 2024, the first since 2015 – fees will remain stable for 2025. IHS offered a new category of membership for Allied Healthcare Professionals, e.g. physiotherapists and other manual therapists – the cost of Allied membership matches the cost of Junior and Nurse membership. Associate membership is still offered to members from low and lower-middle income countries, and a discounted rate offered to members from upper-middle income countries; juniors from upper-middle countries are offered free of charge Associate membership. Associate membership numbers also continued to grow. Five new Affiliate Member Societies joined in 2024 – Bangladesh, Bolivia Chile, China and Ethiopia; IHS currently has 58 Affiliate Member Societies representing 56 countries.

The Standing Committees and Special Interest Groups (SIGs) continued to be active on behalf of the Society.

The European Corporate Roundtable brings together industry partners, IHS representatives, patient advocates and a European Medicines Agency representative. The main purpose of the Corporate Roundtable is to hold a dialogue between all stakeholders to enhance the efficiency of drug development in the European Union and evaluate/minimise barriers to access to new drugs and devices for appropriate patients. The Corporate Roundtable met in May and December to discuss clinical trial innovation, clinical trials in cluster headache, proposed IHS guidelines, headache medicine prescribers, and access to improved healthcare in areas of unmet need.

The Standing Committees and Special Interest Groups (SIGs) continued to be active on behalf of the Society.

The Clinical Trials Committee published one Guideline document: ‘Guidelines of the International Headache Society for controlled trials of pharmacological preventive treatment for persistent post-traumatic headache attributed to mild traumatic brain injury’.

The Communications Committee continued to heighten IHS’ profile in social media. Under the guidance of the Communications Committee Chair, IHS enhanced its online profile through the social media channels and the Society is now increasingly active, highlighting new and general headache medicine advancements on a daily basis, giving IHS a strong online presence. Headache awareness campaigns were run on IHS social media channels and the website on cluster headache, trigeminal neuralgia, World Headache Awareness Week, and Migraine Awareness Day. Each campaign includes three videos on ‘What is’, ‘How to diagnose’ and ‘How to treat’ the disorders, with the videos in several different languages.

The IHS Education Committee sent a Visiting Professor to the Philippines. The Committee also continued to add to the collection of videos and podcasts in the website Online Learning and Education Centre, and hold webinars on different headache subjects during the year. Some of this content is available only for members, others for public view. Some of the public view content was also uploaded to a new IHS page on the VuMedi educational platform used by clinicians worldwide which has broadened the reach of IHS educational content. The second IHS Learning Institute course (for IHS members only), on cluster headache, was launched. The International Headache Congress (IHC) 2023 presentations were posted on the IHS website for member access.

In collaboration with the World Organization of Family Doctors (WONCA) Europe IHS developed an online course similar to the Learning Institute designed for primary care physicians, with the aim of increasing awareness of headaches and related disorders among family physicians. The course consists of three modules, each based on a case study, with pre- and post-learning test questions, allowing participants to assess their learning. Following the launch a webinar was held to promote the course with speakers from IHS and WONCA Europe.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

The ninth International Headache Academy (iHEAD) was held in Berlin in May, immediately prior to the IHS 2024 | Science conference; 56 delegates attended from 29 different countries. iHEAD aims to advance headache education and facilitate mentorship for the next generation of headache specialists and key opinion leaders in the region. Delegates are carefully selected by the Scientific Steering Committee collaborating with the IHS Juniors Group and regional headache societies. The educational content is directed by the Scientific Steering Committee, which develops a comprehensive agenda combining the latest research in headache care with instruction in practical approaches to research, clinic-based medicine and professional development. iHEAD targets a dual need: 1) to attract young physicians to pursue a career in headache medicine; and 2) to raise the level of education on headache across the different countries. Attendees are given the education and skills necessary to return to their countries of origin and develop and improve the practice of headache medicine locally. Three review papers for submission to Cephalalgia are being written by iHEAD 2024 faculty in collaboration with delegates. Three review papers from iHEAD 2023 have been published in Cephalalgia; one other is being finalised.

A Visual Aura Table was published where, for the first time, headache researchers show the full spectrum of aura visual disturbances in a standardised way. The aura table has been tested in a large, multicentre international population among 215 migraine with aura patients and the results published in Cephalalgia. The Table is freely available and downloadable. IHS endorses its use to describe migraine aura better and more accurately, both clinically and in research settings. The goal is that the Table will be used for the benefit of patients and healthcare professionals around the world.

IHS held the first Regional Outreach ProgrammE of IHS (ROPE-IHS) in Malawi in 2022; the initiative was highlighted as part of the article ‘Globally advancing neurological education in headache’ in the September 2024 issue of the Lancet Neurology

Six Headache Trainee programmes and 10 Short-stay Scholarships enabled young physicians from lower-income countries to spend up to 12 weeks and 8 weeks, respectively, in leading headache centres in Spain, Italy, Turkey, USA, Denmark, Germany, Portugal, Netherlands, Switzerland and UK). The aim of these programmes is to increase transnational mobility of young researchers living in lower-income countries by providing grants for short, goal-directed stays in headache centres and research institutions.

Three Junior research grants for scientific projects were awarded, one based in Sweden, one in Cameroon and one in China; the projects were reviewed and selected by the Juniors Group. The Juniors Group continued their virtual mentoring programme to promote global mentorship, collaborations, and support within the Society. Mentors and mentees were paired based on either clinical, research, advocacy interests or career paths.

Two Headache Science awards were offered to recognise promising early- and mid-career basic, clinical or translational scientists whose research has contributed to the headache field. The two recipients in 2024 were from Denmark and Spain and will give a short presentation of their research work during IHC 2025.

The Women’s Leadership Group changed their name to Women Inclusion Diversity Equality (WIDE) and published an Inclusion and Diversity Statement on the IHS website.

Two new Special Interest Groups were created – Headache and Vascular Disorders and Physiotherapy. The Physiotherapy SIG held a webinar in collaboration with the Education Committee to introduce the work of the group.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

A Global Burden of Disease (GBD) Task Force was formed to work with collaborators and the leaders of the GBD, the largest and most comprehensive effort to quantify health loss across places and over time, so health systems can be improved and disparities eliminated providing a global population health map and keeping track of it. It is important that all headache disorders are categorised in the GBD and a strong group of experts from partner organisations will join the task force to ensure that they are included. In response to the GBD2021 study published in Lancet Neurology in 2024, IHS published an article calling for recognition that change is overdue: migraine must be acknowledged as a serious but largely remediable medical condition and incorporated, with the priority it deserves, into the public health strategies of all countries. Alongside this recognition, IHS also called for acknowledgement by health-policy makers of the need both to promote research into the causes and consequences of migraine and to translate research findings into actionable public policy, and extended an invitation to all IHS Affiliate Societies, as well as to every neurological and pain association, to join in championing migraine awareness and advocating for the legitimacy and urgency of these objectives.

A collaboration with several stakeholders including the American Headache Society (AHS), National Institute for Neurological Diseases and Stroke (NINDs), national and international scientists and clinicians, and patient organisations identified eight critical research priorities for the headache field. These priorities will guide research over the next decade and improve outcomes for individuals with headache disorders. The paper was published in the AHS journal, Headache.

Following a request from the World Health Organization (WHO), IHS collaborated with Lifting the Burden (LTB), the European Headache Federation (EHF) and DREAM (Disease Relief through Excellent and Advanced Means) to make recommendations to WHO for addition of drugs for the treatment of headache to the WHO List of Essential Medicines. The proposal was submitted to WHO in November 2024.

The Society continued to collaborate with the International Association for the Study of Pain (IASP) holding a joint session at the World Congress of Pain in the Netherlands, with two speakers from IHS.

IHS continues as a member of OneNeurology, an initiative conceived by the European Federation of Neurological Associations and the European Academy of Neurology (EAN) that has led to a wide partnership involving numerous international disease-specific organisations and regional umbrellas with the aim to ensure recognition and support for the wide range of neurological disorders. This will be achieved with multiple initiatives, from capacity building to awareness raising.

Through the diverse in-person/virtual educational events and other initiatives IHS reached healthcare professionals worldwide to educate on headache medicine and research. The online learning centre, with much free access content, reaches people interested in headache worldwide and includes education courses on migraine and cluster headache, and the headache awareness campaigns which have a global remit for anyone interested in headache, from all medical disciplines, primary care and headache patients. In total 19 grants were awarded either for in-person clinical visits or for scientific research. The positive impact of the various IHS grants has been recognised through a survey of past grant recipients, the results of which were published in Cephalalgia (Puledda F, et al. A history of International Headache Society grants and their impact on headache careers. Cephalalgia 2022;42(11-12):1288-1293. doi:10.1177/03331024221107384, and IHS continues to retain contact with past grant recipients to keep informed of their careers.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

Several congresses/courses were offered the opportunity to run under the auspices of IHS during 2024:

2nd Advanced Training Seminar on headache disorders, Roma, Italy, March/November 202
5th Master of Headache Disorders programme, at the University of Copenhagen, Denmark
6th AMCEMIG, Merida, Mexico, 26-28 September 2024
National Association of Pain Medicine Armenia - Current approaches to headache management, Yerevan, Armenia, 11-12 October 2024
8th Iranian International Headache Congress, Isfahan, Iran, 16-18 October 2024
XII ANIRCEF national congress, Savona, Italy, 28-30 November 2024
Global Migraine and Pain Society, 9th MENA Meeting and 5th Turkish African Meeting of Headache and Pain Management, Istanbul, Türkiye, 1-3 November 2024
ARCH2024 – 10th ARCH Congress, Sri Lanka, 18-19 December 2024.

IHS also offered support to a letter instigated by the European Brain Council:

European Brain Council Joint Letter “Urgent Call to Action: A Place for Brain Health at the Top of EU Policy Agendas”

IHS continued collaborating with producers of a television documentary on headache: ‘Headed for the Future’. The documentary will highlight the progress within the field of headache disorders and science with the message that headache science will lead to improved quality of life for patients. The target audience will be the general public, health policy makers and healthcare professionals. The three episodes will involve interviews with leading scientists, headache specialists, patient advocates and patients enrolled in clinical trials throughout the world. During 2024 the episodes were finalised and release is expected during 2025.

The second Regional Headache Conference, IHS 2024 | Science, a small regional meeting, was held in Berlin in May. This was a unique, intimate meeting which highlighted some of the most significant scientific and clinical advances underway. This scientific meeting brought together world experts and new leaders to present and discuss the latest developments in basic and clinical headache science. This smaller focused conference offered the delegates the opportunity to network and interact closely with key leaders in the headache field.

The Executive Director’s contract ended and IHS began the process of identifying an Association Management Company to increase the administrative support for the society and its projects.

Carol Taylor continues to provide administrative assistance to the Society with assistance from Chelsea Thomas, and Intermarketing Agency supports the website. MHA are engaged for financial services.

I am grateful to the Trustees, Standing Committees and Special Interest Groups and Affiliate Societies for their activities on behalf of IHS throughout 2024.

Financial review

Investment policy

The Trustees consider social, environmental and ethical considerations when investing. The Society held significant cash reserves as at 31 December 2011 of £1.4m and a decision was made by the Board in early 2012 to invest £500k in specialist quoted charity investments with J P Morgan to generate higher revenue in capital returns.

In September 2016 the J P Morgan products were no longer available and were sold for £643k. In November 2016 £600k was reinvested in four Schroder Unit Trust Funds. In 2023 one of the funds was discontinued and the IHS funds returned to the society’s bank account. In 2024 a second account was sold by IHS and the funds return to the society’s bank account in 2025.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

In 2017 it was recommended and subsequently agreed by the Board to invest £250k in the Diversified Property Fund for Charities (DPFC) managed by Eskmuir Asset Management Ltd. This was concluded in August 2017. A further £250k was invested in the DPFC in September 2018.

Any significant surplus cash held by the Society is placed on bank deposit. The Trustees consider this gives a reasonable return at very low risk and allows the flexibility to have easy access to funds at short notice should demands be made on the Society in order for it to achieve its charitable objectives.

The Trustees consider that the investment performance was satisfactory and investment objectives had been met.

Reserves policy

At 31 December 2024 the group's total funds were £3,201,364 (2023: £2,999,356) of which £3,135,397 (2023: £2,919,487) were unrestricted and £65,967 (2023: £79,869) were restricted.

At 31 December 2024 IHS Trading’s total funds were £(276,105) (2023: (200,400)) this fund is in deficit.

Certain of the group's income arises only in alternate years. In addition, grants and donations received can vary significantly from year to year. At this stage in the group's development the Trustees consider it appropriate to maintain a general reserve in the region of two to three times the expected annual expenditure (£1.5m to £2.3m) which is in line with similar not for profit international organisations. Should the group's income fall unexpectedly, this general reserve would be used to enable it to plan and execute in good order either a reduction in its activities or an improvement in its income stream. The Trustees acknowledge that the current level of reserves is high and the Treasurer will continue to take steps to address the situation as the Society’s activities continue to increase.

Financial activities and affairs

As shown in the statement of financial activities on page 22, the group had total income of £705,217 in 2024 (2023: £894,676) and net increase in funds for the year before tax of £202,008 (2023: £90,257 decrease before tax).

The group’s income was made up from several sources. Royalty income from the Society’s journal Cephalalgia totalled £110,411 (2023: £145,147) and membership fees reached £137,336 (2023: £150,067).

There was income from its trading subsidiary of £82,553 (2023: £58,395).

In addition, the company received investment income from its investments and bank deposits totalled £152,219 (2023: £150,148).

The group had total expenditure of £658,495 in 2024 (2023: £923,486). Of the total expenditure in 2024 £29,672 (2023: £109,018) was restricted.

The group’s expenditure included governance costs of £78,399 (2023: £105,716), grants and expenditure made in furtherance of the charity’s objectives of £53,042 (2023: £133,513), educational development costs including the Open Learning centre and two Master Course (Copenhagen) totalled £31,146 (2023: £202,432), costs of its journal, Cephalalgia, of £10,025 (2023: £16,605), committee expenses of £3,027 (2023: £Nil) and support costs of £274,721 (2023: £271,632).

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

Going concern and consideration

The Trustees have assessed the use of going concern and have considered possible events or conditions that might cast significant doubt on the ability of the Group to continue as a going concern. The Trustees have made this assessment for a period of at least one year from the date of the approval of these financial statements. The Trustees have concluded that there is a reasonable expectation that the Group has adequate resources to continue in operational existence for the foreseeable future. The Group therefore continues to adopt the going concern basis in preparing these financial statements. The Trustees are not aware of any post balance sheet events which would have a material impact on these financial statements.

Grants and donations

All of the Society’s resources are dedicated to the achievement of its objectives. There are occasions where it is appropriate to make grants (and to provide support) to individuals and institutions towards the costs of activities and events undertaken for reasons complementary to the Society’s objectives. In addition, there are cases where other institutions working on a similar agenda are better placed to achieve the Society’s objectives. In those cases, the Society may choose to donate some of its financial resources thereto. The Board of Trustees considers all grants and donations in detail prior to giving approval (or otherwise).

Plans for future periods

IHS will continue work to strengthen existing partnerships and establish new strategic relationships which will allow the Society to extend its educational reach and influence regional, national, and global policy makers that will facilitate drug development, remove barriers to care, and improve access to new and emerging therapies.

IHS will work to make headache medicine available in lower-income countries throughout the world. It is recognised that in these countries most headache sufferers cannot seek medical advice from a doctor, but instead see clinical officers, nurses and community healthcare workers who do not have knowledge of headache medicine and no access to therapies on the World Headache Organization (WHO) List of Essential Medicines. IHS will develop tools for educating these healthcare workers in using diagnostic tools they can understand and applying therapeutic tools (i.e. medications) available to the communities they serve. The initiative will begin with pilot projects in Kenya and the Philippines.

IHS will organise a second Regional Outreach ProgrammE of IHS (ROPE-IHS) in collaboration with the DREAM (Disease Relief through Excellent and Advanced Means) programme in Malawi. The initial survey in Malawi highlighted the lack of proper training in neurology and headache. Following the first ROPE-IHS, the after-course survey showed a great improvement in their knowledge of neurology, pain, and primary and secondary headache. The aim of the second event is to create a self-sustainable educational programme – the training will be expanded to reach more clinical officers, and there will be further collaboration with two local healthcare professionals who will be trained as IHS ambassadors and part of the faculty of the training event.

Through the Access to headache care in low- and middle-income countries, ROPE-IHS and Visiting Professor programmes IHS will continue to reach areas where there is little or no headache education or infrastructure. Specific local healthcare professional needs will be carefully considered when designing the programmes to determine the best modalities to reach out to these countries in order to foster improvement. These activities will continue to focus on Africa, Central and South America, and Asia.

IHS will continue to seek representation in lower income countries through the Affiliate Member Societies and fund educational activities and content. Associate Membership will be actively promoted through the Affiliate Societies at their meetings and courses to further highlight the work of the Society and increase knowledge and headache research in these regions. IHS will also promote membership to national general neurology societies, in particular those countries to which free of charge membership is offered, and help to establish headache societies in lower-income countries.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

IHS is represented throughout Asia with the Asian Regional Committee for Headache (ARCH), and will continue to support activities in this region and try to promote headache research among general neurologists.

IHS will continue to expand its partnership with the International Association for the Study of Pain (IASP) and representatives from IASP will join the International Headache Congress (IHC) in São Paulo for a joint IHS-IASP symposium.

The 22nd IHC will be held in São Paulo, Brazil, in September 2025. The Juniors Group will offer travel grants to facilitate IHC attendance for junior members and a Juniors Forum will be held to encourage networking amongst Junior members. During the congress past Fellowship, research grant and Headache Science Award recipients will give short presentations of their work. The location for the 23rd IHC in 2027 will be agreed.

The Clinical Trials committee will develop guidelines on menstrual migraine and digital therapeutics. Work will continue with the Italian Headache Society to finalise the joint evidence-based guidelines for migraine prevention and treatment which will be published in Cephalalgia. Work will also continue on real world data studies in headache and a position statement advocating for higher standards for migraine prevention will be published.

The Society will adapt the published global practice recommendations for the acute and preventive treatment of migraine for use in countries where only the drugs of the WHO’s List of Essential Medicines are accessible. IHS will assist in fostering optimisation and harmonisation of migraine treatment across countries and improve the availability of anti-migraine drugs in regions with limited access. The initiative is perfectly in line with the Intersectoral Global Action Plan 2022–2031 launched by the WHO in May 2022 for improving access to both services and support for neurological conditions all over the world.

The Classification Committee will continue work on the update of the International Classification of Headache Disorders, 4th edition.

The 9th International Headache Academy (iHEAD) will take place in São Paulo, Brazil, immediately before the IHC.

In 2024 IHS will continue focus on online educational activities with further webinars, educational videos and podcasts being released in the Online Learning and Education Centre, and more Learning Institute courses on spontaneous intracranial hypotension and primary care. In collaboration with the Education Committee, the Child and Adolescent Committee will continue a webinar series on the understanding and management of headache disorders in children and adolescents. Work will start on new initiatives to produce animated videos to highlight primary and secondary headache disorders and also online clinical case presentations.

Four Visiting Professors meetings will be available – Affiliate Societies and contacts from lower-income countries can request a Visiting Professor. The aim is to send headache specialists as representatives of IHS to attend regional meetings, or teach at a headache centre, in countries that might need or want increased headache education and motivation and where, without financial support, attendance of an international specialist would not be possible.

Three Fellowships will be offered, one restricted to an application from a lower-income country. The Headache Trainee and Short-Stay Scholarships programmes will be open to facilitate attendance of physicians from lowerincome countries to visit specialised headache institutions abroad and actively increase knowledge on headache disorders and specialised headache management.

The Juniors Group will offer three Junior Research Grants, for basic or clinical research, to support innovative and impactful research from young investigators, promote the career of young investigators in the field of headache, and increase the knowledge base of headache disorders. One of these grants will be restricted to research in lower-income countries.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

The Child and Adolescent Committee will offer seed funding to initiate projects that study headaches in children and adolescents in lower-income countries.

Two awards will be offered to recognise promising early- and mid-career basic, clinical or translational scientists whose research has contributed to the headache field. The award winners will deliver a short presentation of their research at the IHC in September 2025.

The first Jes Olesen Awards, recognising outstanding contributions in headache medicine across both clinical and basic sciences, will be awarded to the best original research papers and presented during IHC 2025.

The Society will continue to closely interact with its international Affiliate Member Societies, encouraging their members to join IHS at a preferential rate through their national society and gathering educational materials for the Online Learning and Education Centre in multiple languages.

The Communications Committee will continue to forge relationships with doctors and researchers all over the world, and actively promote IHS activities through social media platforms. In collaboration with the Education Committee, the Committee will continue to support different headache disorders awareness campaigns.

To facilitate collaboration between headache specialists worldwide, Exchange Groups will be initiated. This new initiative will aid to further enhance engagement and ensure that the needs of the growing international headache community are fully met. The Exchange Groups will provide members access to opportunities including enhanced connections, professional growth, networking, collaboration, and leadership development.

A new Regional Committee will be established to replace the dissolved Linguistic SIGs. A Regional Committee will be more impactful than the Linguistic SIGs and follow the path of ARCH – now with 15 member countries. The Committee will facilitate close liaison with local countries with similar economies and needs and liaison with larger headache centres in neighbouring countries. IHS has identified nine possible regions, including higherand lower-income areas.

The newly re-formed Cluster Headache Special Interest Group will identify projects. Cluster Headache remains undiagnosed and under-treated and greater visibility is needed for this debilitating condition.

The television documentary, ‘Headed for the Future’ will be released on the IHS website with the videos being publicly available on the IHS YouTube channel.

Elections for the President-elect and three new elected Trustees will be held during the Annual General Meeting.

Due to the ongoing conflict between Russia and Ukraine, IHS will continue to not accept any new member applications or grant applications, or hold any activities in Russia or Belarus until further notice. The Society will be ready to help Ukrainian doctors and researchers through scientific/clinical initiatives, projects and educational opportunities when the conflict is over.

An Association Management Company will be engaged to strengthen and streamline IHS administration. IHS is engaged in many activities which are important for the headache world but they are not well known and deserve better recognition. IHS will strengthen its public relations through the Association Management Company to ensure that the work of the society is promoted.

Other matters

Statement of disclosure to the auditors

As far as the Trustees are aware, there is no relevant audit information of which the company's auditors are unaware. All of the Trustees have taken all steps that they ought to as directors in order to make themselves aware of any relevant audit information and to establish that the company's auditors are aware of that information.

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

INTERNATIONAL HEADACHE SOCIETY (A company limited by guarantee)

TRUSTEES’ REPORT FOR THE YEAR ENDED 31 DECEMBER 2024

Preparation of the report

This report has been prepared taking advantage of the small companies’ exemption of section 415A of the Companies Act 2006 and taking advantage of the small companies' exemptions in preparing the Directors’ report and from the requirement to prepare a strategic report.

Auditors

The auditor, MHA, previously traded through the legal entity MacIntyre Hudson LLP. In response to regulatory changes, MacIntyre Hudson LLP ceased to hold an audit registration with the engagement transitioning to MHA Audit Services LLP.

The auditors, MHA, have indicated their willingness to continue in office.

This report was approved and authorised for issue by the Trustees and signed on its behalf by:

…………………………… …………………………… F Ahmed R Burstein Treasurer President

Date: September 18, 2025

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Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

September 18, 2025

Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

September 19, 2025

Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

September 19, 2025

Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE

September 19, 2025

Docusign Envelope ID: BC1EB29D-D203-42A6-8B70-AA7C202AA2DE