Patients often ask why we don’t do blood tests for the diagnosis of their headaches. The truth is, after forty years of research into headache disorders, the science (not popular beliefs, fads or what snake oil salesmen say) clearly state that doing blood tests adds no value to diagnosing headaches or figuring out the best treatment. I often do blood tests because the patient or the family demands it. It is too hard for me to convince them that it is a waste of money and time and only distracts from the real treatments that have the best chance of working . . . so I cave in. If I don’t do the tests, they will often interpret this as I don’t care, so they walk away and their chance of finally getting better is greatly diminished. I want them better so I try to accommodate their wishes as best as I can so they will stay long enough for me to help them.
In the past, the only exception about blood tests is that we do a couple of inflammatory blood tests in older patients (over 55) who have a new onset of headache to rule out a rare disorder of Giant Cell Arteritis.
I know that the naturopaths do a lot of blood tests looking for the “cause” of headaches. But that is not based on science or headache research but on their philosophy. Of course everyone wishes they had a simple cause that could be cured with a vitamin, but that is not reflected in reality. Even if you do have food allergies, the science, so far, has said that that there is NO relationship between migraine and allergies.
It is likewise true about checking hormone levels. It is every migraine sufferer’s wish (except for males of course) that having hormones “out of whack” is what is causing their headaches and then fixing them with supplements will fix the migraines. There is no question that shifting estrogen levels can be a strong trigger (not cause) for migraine attacks but it is not because the hormones are whacky . . . it is because the brain is genetically whacky and responds to the hormones in error by causing a headache. The research has shown that adding supplemental hormones does not help migraines and often causes them to get worse and can increase a patient’s risk for stroke. The only exception is that sometimes shutting down the menstrual cycle with hormones can help menstrual migraine. So why would we do those tests?
The research has shown that doing a Lyme test (titer) has no value in diagnosing or treating chronic headaches. One patient now and then will testify that when they went on Lyme disease treatments, their headaches got better. But when you take a large group and study them, the Lyme disease treatments makes no difference. I have many, many patients who have gone through Lyme disease treatments with no benefits for their headaches. Most likely the few who do improve (and go on to write blogs about it) just happened to go through a natural cycle of improvement while they were doing the six month treatments. Headaches are always cycling in and out and that’s why there are so many myths about secret cures (and when you shine the light on them with real research, they are proven to be ineffective).
Now, things may be about to change. For the first time a very reliable blood (see this link ) test has been found that diagnoses migraine. That test showed that a certain group of lipids, sphingolipid ceramides, are significantly lower in migraine sufferers. It was so reliable, that in the study, you could predict who had migraine based on the blood test alone.
This test is not available to the public yet. The benefit of this test is to help us sort out who really has migraine and who may have some other kind of headache. It will also add to the support (like the study seeing migraine on MRIs which was published last year) that migraines are real, biological and needs the same respect as MS or any other serious medical condition.
It is hard to say if this marker would change the course of treatment now or in the future. It is not clear why these lipids are lower. It is not a simple “sphingolipid ceramide deficiency” and taking some supplement with these lipids will cure the migraines. This low level of the lipids will probably be related to a byproduct to the complex system that the brain uses to cause a migraines.
J. Michael Jones, MPAS-C