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Background.-Borderline personality disorder (BPD) may be disproportionately common in the migraine patient population, but specific migraine features in the BPD subgroup remain incompletely characterized.Purpose.-To define more clearly the clinical characteristics of migraine patients with BPD, to evaluate their clinical response to aggressive headache management, and to assess the sensitivity of an instrument intended to screen for the presence of BPD.Methods.-We evaluated 50 consecutive patients with migraine and previously documented BPD, 50 consecutive patients with migraine of all types and no history of BPD, and 50 patients with migraine and no history of BPD matched to the first group for age, gender, and headache frequency. We assessed a variety of demographic and clinical variables at baseline, and to all patients we administered the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Patients in Groups 1 and 3 were treated for their headaches via a uniform pharmacologic management program. Treatment outcome was assessed after 6 months.Results.-In this series of migraine patients, coexisting BPD was associated with female gender, more pervasive headache, more migraine-related disability, a higher prevalence of medication overuse headache, more unscheduled visits for acute migraine treatment, a higher prevalence of active, self-reported depression, and a lower likelihood of responding to pharmacologic therapy intended for headache management. The MSI-BPD was insensitive in detecting BPD.Conclusions.-Migraine patients with coexisting BPD are clinically distinct from the migraine patient population as a whole; in particular, they are more severely affected by their headache disorder and more treatment refractory. Simple screening instruments used to detect BPD may be ineffective in the headache clinic setting.

The "leaky pipeline" of women in science, technology, engineering, and mathematics (STEM), which is especially acute for academic mothers, continues to be problematic as women face continuous cycles of barriers and obstacles to advancing further in their fields. The severity and prevalence of the COVID-19 pandemic both highlighted and exacerbated the unique challenges faced by female graduate students, postdocs, research staff, and principal investigators because of lockdowns, quarantines, school closures, lack of external childcare, and heightened family responsibilities, on top of professional responsibilities. This perspective provides recommendations of specific policies and practices that combat stigmas faced by women in STEM and can help them retain their careers. We discuss actions that can be taken to support women within academic institutions, journals, government/federal centers, universitylevel departments, and individual research groups. These recommendations are based on prior initiatives that have been successful in having a positive impact on gender equitya central tenet of our postpandemic vision for the STEM workforce.W omen in scientific fields continue to face an uphill struggle with under-representation, salary discrepancies, and increased career-related hardships. Despite progress over the past decades, these challenges were significantly aggravated by the COVID-19 pandemic and have accentuated the so-called "leaky pipeline", a model that depicts how women in science, technology, engineering, and mathematics (STEM) have missed opportunities due to gender bias and existing structural obstacles. These barriers affect all facets of the scientific enterprise, including publishing, hiring, funding, and advancement into more senior positions. 1,2 The consequence is a stagnant gender gap among researchers and faculty, despite significantly increased numbers of women receiving advanced degrees in STEM. 3−5 Broadly speaking, more than 70% of STEM laboratories have male principal investigators (PIs), and these laboratories are less likely to include female graduate students and postdoctoral trainees. 6 Women are also 10−20% less likely to earn the title of PI compared to male peers. 7,8 On average, startup funds offered to women are ∼$500,000 less than those garnered by their equivalently qualified male counterparts. 9 When manuscripts written by women are reviewed by all-male teams of reviewers, their work is less likely to be accepted for publication. 10