Fuelled by a passion for research, and inspired by a “heartbreaking” case she encountered early on in her career, Simona Sacco (L’Aquila, Italy) has made a number of significant contributions to the neurology field—perhaps most prominently through her current tenure as president of the European Stroke Organisation (ESO). Here, Sacco—professor of neurology at the University of L’Aquila and director of the Neurology and Stroke Unit at Avezzano-Sulmona-L’Aquila Hospitals—discusses her key mentors, the current landscape of stroke and migraine management, and much more.
What initially attracted you to medicine, and the field of neurology specifically?
My father is a doctor, and he really encouraged me to pursue a career in medicine. I’ve always been fascinated by how the brain works, and neurology was the perfect field to fuel my passion for research. When I started out, the brain was a big mystery, and—while we understand a lot more now—it still holds many secrets. I also love clinical neurology because it’s all about clinical reasoning—listening to patients’ histories, doing physical exams, and piecing together even the smallest clues to arrive at a diagnosis. It’s like solving an intriguing puzzle every day, blending solid science with the chance to make a real difference in people’s lives. That’s what keeps me excited about my work.
Who have your mentors been and how have they impacted your career?
My mentor was Antonio Carolei, the former chair of my current department. He played a pivotal role in shaping my career, teaching me far more than just neurology. He instilled in me the importance of being methodical, paying attention to details, thinking outside the box, standing up for my ideas, and always acting with dignity and integrity. He also gave me invaluable opportunities and pushed me to step outside my comfort zone, even when it was difficult. These experiences were instrumental in shaping both my professional and personal growth.
Beyond this formal mentorship, I have been fortunate to work alongside and learn from exceptional leaders in the fields of stroke and headache. Collaborating with experts such as Messoud Ashina, Paolo Calabresi, Martin Dichgans, Urs Fischer, Peter Kelly, Paolo Martelletti, Else Charlotte Sandset, Cristina Tassorelli, and many others, has been an extraordinary privilege. Each of them has been a role model and, by observing and working with them, I have gained invaluable insights that have shaped my own leadership style. I feel truly lucky to be part of such an inspiring and supportive community.
Could you outline your major achievements and other highlights from your time as ESO president?
My time as ESO president is still ongoing—with more than one year left to go—so I haven’t reached all my goals yet. However, I’m proud of the work we’ve started and the direction we’re heading. At ESO, I’m committed to upholding our high ethical and quality standards while pushing forward our main programmes. One of our key initiatives is the Stroke Action Plan for Europe (SAP-E), an ambitious programme aimed at improving stroke prevention, treatment, and life after stroke, by 2030. This effort requires a lot of energy and resources, and I’m excited to be part of it. I’m also working on shaping policies to improve stroke prevention through advocacy and partnerships with other societies. On top of that, education is very important to me. I’m dedicated to creating a welcoming and open environment where everyone who wants to contribute can help ESO grow and succeed.
Based on your experience, do you have any advice for future leaders of the ESO and other societies in the field of stroke care?
For future leaders in stroke care, my advice is to stay dedicated to the cause and be prepared for a significant time commitment. Always keep patients at the forefront—improving their healthcare should be your biggest priority. Investing in the education and growth of younger professionals is key as well as working on implementation of best practices without disparities. Stay vigilant, hold yourself to the highest ethical and behavioural standards, and actively seek out dialogue and collaborations. Above all, have a clear vision of where you want to take your society, and try to look ahead of times to anticipate what’s coming next.
What do you feel has been the most important development in the field of neurology during your career?
Neurology has changed in ways that were hard to imagine when I first started. We’ve gone from limited tools to an era where we can diagnose diseases more precisely thanks to biomarkers and imaging breakthroughs. In stroke care, the introduction of reperfusion therapies, like thrombectomy and thrombolysis, has completely changed the game. These treatments save lives and significantly improve recovery outcomes, something we couldn’t achieve decades ago. What’s exciting is that we’re not stopping here—new treatments and technologies are in the pipeline that could make an even bigger impact. It’s been incredible to witness this transformation, and it feels like we’re only scratching the surface of what’s possible in neurology.
Which of the studies you have been involved with do you believe has had the greatest impact on stroke care?
I believe the most impactful contributions I’ve made are my epidemiological studies. By examining stroke patterns and outcomes in the population, these investigations have helped clarify both our progress to date and the areas where we still have work to do. That information is essential for guiding improved prevention strategies, tailoring treatment approaches, and ultimately helping us shape more effective healthcare policies.
Besides your own work, what is the most interesting piece of stroke research you have seen in the past year?
One of the most intriguing areas of stroke research in the past year revolves around intracerebral haemorrhage (ICH). For years, this condition has lacked any effective treatment, which has been a significant challenge in stroke care. However, recent studies are offering new hope. The concept of a ‘bundle of care’ has emerged as a promising approach. This method focuses on optimising several aspects of care for ICH patients, from blood pressure management and reversal of anticoagulation to stroke unit care and early rehabilitation.
While it may seem straightforward, the strength of this approach lies in its comprehensive and systematic application. Early results suggest that, even without a single definitive treatment, adhering to these evidence-based care bundles can significantly improve outcomes for patients. As we learn more about ICH pathophysiology and refine treatment strategies, these care bundles could eventually be paired with new targeted therapies to further improve survival and recovery rates.
Currently, what are the most pressing unmet needs in clinical research and care for headache?
In recent years, we’ve witnessed a major breakthrough in migraine treatment with the advent of the first preventive therapies targeting the calcitonin gene-related peptide (CGRP) pathway. These treatments have been life-changing for many patients, significantly reducing their migraine frequency and severity. However, they don’t work for everyone, and even some of those who benefit may have a substantial residual migraine burden.
Migraine is an incredibly complex disease. While CGRP is a key player, it’s clear that other important mechanisms are also involved. To truly address the unmet needs in migraine care, we need to dig deeper into these alternative pathways. Promising targets like pituitary adenylate cyclase-activating polypeptide (PACAP) are already in the pipeline, but we need a much broader range of specific treatment options. Expanding our understanding of migraine mechanisms and developing diverse, targeted therapies are essential steps toward personalised and effective treatment for all patients. Only by addressing this complexity can we hope to reduce the burden of migraine across the board.
What is your involvement in the Global Burden of Diseases (GBD) project, and why is this project important?
My involvement in the GBD project has been exciting. I collaborate by analysing and interpreting the data, especially for conditions like stroke and migraine. This project is a gamechanger because it not only shows us how widespread these conditions are, but it also provides essential insights that help us plan current and future care services. The data and projections from GBD are crucial for shaping healthcare policies and ensuring that resources are directed where they’re most needed. Being part of this project gives me the opportunity to contribute to a better understanding of neurological diseases on a global scale and to advocate for improvements in public health.
Could you describe one memorable case and the effect it had on you as a physician?
Early in my career, while working in a rehabilitation facility, I encountered a case that profoundly shaped me as a physician. A young, healthy patient had suffered a vertebral artery dissection that led to locked-in syndrome. She was unable to move or speak but was fully conscious—a heartbreaking condition. Tragically, she hadn’t received revascularisation treatment because she lived in an underserved area where access to advanced stroke care was limited. This case left a deep impression on me. It highlighted the devastating consequences of inequities in healthcare and inspired me to dedicate my energy to improving stroke care for everyone, regardless of where they live. It became my driving force to push for better access, more awareness, and advancements in stroke prevention and treatment. Her story is one I carry with me to this day, reminding me why the fight for equitable healthcare is so important.
What are your interests outside medicine?
I absolutely love travelling. It’s amazing to discover new places, cultures, and food. I particularly love nature and people. I also enjoy spending time with my daughters (Maria Stella and Anna), my husband (Mario), and our lovely cat (Leo). On top of that, I’m into reading books, hanging out with friends, and going to parties—especially if there’s dancing involved!
Of all the countries you have travelled to, which is your favourite?
It’s hard to choose just one, but I have a special place in my heart for Vietnam. I love it for its beautiful nature and incredible landscapes, which are simply breathtaking. The rich culture and the kindness of the people really stand out to me. It’s also fascinating and touching to learn about the stories of the Vietnam War, and to see the deep, lasting marks it left on the country and its people. Experiencing everyday life in Vietnam is equally compelling—there’s a strong, unique identity there that makes every visit unforgettable.
What do you think you would be doing for a living today if you had not chosen a career in medicine?
It’s hard to say for sure. I tend to love whatever I do, and I find passion in many different areas. Photography, for example, really attracts me. I can easily imagine myself as a street photographer, capturing the rich tapestry of human life and the diverse cultures around us. The idea of telling stories through images and exploring the world from that creative angle is something that really resonates with me.
FACT FILE
Current appointments:
- Full professor of neurology, University of L’Aquila
- Director, Neurology and Stroke Unit, Avezzano-Sulmona-L’Aquila Hospitals
- Director, residency programme in neurology, University of L’Aquila
Education:
- 2005–2007: Master in cerebrovascular diseases, University of L’Aquila
- 1999–2004: Specialisation in neurology, University of L’Aquila
- 1993–1999: Degree in medicine and surgery, University of L’Aquila
Honours (selected):
- 2024–2026: President, European Stroke Organisation
- 2021–2023: Second vice president, European Headache Federation
- 2019–2022: Chair, Research Center, Italian Headache Society
- 2018: Outstanding Reviewer Award, Stroke journal
- 2016–2019: Member, Scientific Panel for Stroke, European Academy of Neurology
