I wanted to share here our latest handout:
What “Causes” Headaches from an Evidence-based Medicine Perspective
Evidence-based, or what some people call “Western medicine” is simply what the name implies, we do not make statements that are not backed up with good, scientific evidence. Good evidence is that evidence which is proven, mathematically, to be better than pure coincidence or placebo effect. The term “Western medicine” is a misnomer because most medical practitioners in Asia and the near East practice evidence-based medicine the same way we do here and they attend our same scientific meetings.
When it comes to headache medicine, there is a large and growing world-wide community of smart scientists who have dedicated their entire careers into finding out what causes headaches and how to treat or cure them. All of us who work in headache medicine are on the same page. We at Pacific Rim Headache Center read all the research in headache on a monthly basis and go to week-long training once a year with these headache researchers. We are on top of the cutting edge of real headache research and have dedicated our careers to this knowledge. However, the answers that we have in headache research are not complete at this time and the answers that we do have are very complicated but they are honest and without quick-fix gimmicks. We now know that most common headache disorders are a mixture of genetic flaws (five have been discovered so far) in the brain’s natural headache generator alarm system and life experiences. The brain’s system for creating a headache is pretty well understood at this time and the age of guesswork, speculation and mythology should be over.
For most patients these concepts of headache causality are very hard to grasp. This puts us at a great disadvantage when other practitioners, who are not part of this scientific community, who give very simple explanations and offer (unproven) cures that are based on more on mythology than scientific research. Patients understand these concepts much better, because they are simple, even though they are probably not true. It gives the patient the idea that we have missed something or simply don’t care enough to find these secret “causes” that others have identified. I have met many patients who have spend years, if not decades, going from one fad treatment to the next, still believing these erroneous concepts, hoping for a cure. Yet they are no better today than when they started. It would be one thing if someone told you that you are having headaches because of toxins in the liver and you actually got better and the headaches went away after you had so-called liver or colon cleansing. But I’ve yet to meet a patient where that has happened and I’ve met hundreds who have spent years going those things and are no better.
We don’t oppose our patients seeking care from alternative medicine practitioners. We are for everything that can possibly help. For example, there is evidence that acupuncture is helpful and we strongly support patients trying it. There are, as of this date, only four nutritional supplements that seem to show some help in headache prevention if taking daily. I encourage all my patients to try them. However, when alternative medical practitioners, or western-medicine practitioners who are not headache specialist just speculate about what causes headaches and how to treat them, and present that personal speculation to the patient as scientific fact, it undermines the patient’s trust in us because it is different from what we have told them. It makes the patient assume that we don’t know something or, as one patient stated it, the “latest treatments.” These people who make these claims have never darken the door to a international headache research meeting, as we do often. Do they read all the research journals on a monthly basis? I’m seriously doubtful.
The follow is a partial list of things that are often presented as the “cause of headaches” but has no evidence at this time in research of being the simple cause. I say “at this time” because research is continuing and one day they may find evidence that could change our minds about this list. If the patient disagrees, I would be happy to look at any scientific evidence that could change my mind that these things are helpful and safe. Testimonials don’t count because they are notorious for being wrong and are often used to manipulate the truth.
Things That Have no Scientific Evidence of Causing Headaches
Hair being too long or too short
Vitamin Deficiencies( including vitamin D deficiency)
Atlas Bone Being Twisted
Loss of Normal Curvature of the Spine
Stress or Depression
Simple Arnold Chiari Malformations of the Brain
Pineal Cyst of the Brain
Black Mold in the House
Allergies to Foods
Hole in the Heart
Nerves Around the Head that are Being Pinched and Need Surgery by a Plastic Surgeon to Fix
Dental Problems, including TJM
Symptoms of Chronic Undiagnosed Diseases Such as Lyme Disease
Low Back Pain
Narcotic Deficiencies (with the thinking just give them more narcotics and their headaches will be fixed)
Headaches Just Being Faked by the Patient to Get Narcotics or as an Excuse to Miss Work
Gluten in the Diet
Parasites in the Colon
“Toxins” in the Colon or Bowel
One Leg Being Longer than the Other
Toxins in the Liver