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Bold claims for migraine treatment are based on opinions and anecdote in this story

Terri Bradford has suffered debilitating headaches all her life. Some days the pain is so bad, she says, “By 11 o’clock in the morning, I’m on the couch in a darkened room with my head packed in ice.”

Over the years, Bradford, who is 50 years old and lives in Bedford, Mass., has searched desperately for pain relief. She’s been to the doctor countless times for countless tests. “Everything I’ve had, I’ve had twice,” she says. “I’ve had two spinal taps; I’ve had so many nerve blocks I’ve lost count.”

Bradford is not alone. It’s estimated that every year 12 million Americans go to the doctor seeking help for headaches. Nearly one quarter of the population suffers from recurrent severe tension headaches or migraines.

People who go to the doctor for headaches are increasingly likely to be sent for advanced testing and treatment, a study finds. That testing is expensive, it may not be necessary and it could even be harmful, says lead researcher Dr. John Mafi, of Beth Israel Deaconess Medical Center in Boston.

Mafi looked at the rates of advanced imaging like CT scans and MRIs in people with headaches, as well as referrals to other doctors, presumably specialists. He found that from 1999 to 2010, the number of diagnostic tests rose from 6.7 percent of all doctor visits to 13.9 percent. At the same time, referrals to other doctors increased from 6.9 percent to 13.2 percent. In other words, almost double what it was a decade ago.

Mafi says this isn’t because more people are suffering headaches. The headache rate has remained virtually the same over the past decade. But what has changed is supply and demand. Today there are a lot more advanced diagnostic machines than there were a decade ago, and more patients are asking to be tested.

“Patients are more assertive than ever before,” Mafi says. “They do research online, are more informed and sometimes go to the doctor demanding, ‘I think I need an MRI.’ ”

And while an informed patient is a good thing, Mafi says sometimes the patient gets it wrong. “I think there’s a subconscious perception that more is better, and that fancier, more expensive tests are better and that equals better care.”

Mafi’s study did not include patients with tumors or other serious problems that can cause headaches. He only looked at otherwise healthy patients who suffered chronic headaches. And in these cases, repeated diagnostic testing can lead to further unnecessary procedures like biopsies.

On top of that, exposure to radiation in tests like CT scans adds up over time and can increase the risk of certain cancers.

For Terri Bradford, the years of searching for effective treatment proved futile. “I’ve been to four neurologists. A lot of them have given up on me because I haven’t gotten any better,” she says.

Eventually Bradford ended up at Beth Israel Deaconess Medical Center, where neurologist Carolyn Bernstein directs the Comprehensive Headache Center. Bernstein says she sees lots of desperate patients like Bradford. “The majority of them have really been suffering a number of years and they’re really miserable with the pain,” Bernstein says. They say, ” ‘I hope you have a magic pill,’ and of course there is no magic pill.”

There is just no single reason why people get chronic headaches, although we do know that migraines have a genetic component and usually a trigger. “If you are a migraine sufferer and I expose you to the right trigger, you’re going to have a migraine,” Bernstein says.

But the triggers are different for different people. They can include poor diet, too much sugar or certain types of alcohol. Problems sleeping, stress, lack of exercise or a combination of any number of these things can cause chronic headaches.

At the headache center, patients receive a thorough medical history that includes headache patterns, disability and mood assessments. Then the center works with patients to try to identify what triggers their headaches and how they can avoid those triggers in the future.

Some people find relief through exercise. “I write an exercise prescription probably as often as I write a prescription for medication,” Bernstein says. She acknowledges it’s sometimes difficult to encourage a patient with cracking head pain to get up and exercise. But even a little can help, and according to Bernstein it doesn’t have to be jogging for miles and miles. It can be yoga, tai chi or even just a little stretching.

A big lifestyle adjustment worked for Terri Bradford. She started exercising and changed her diet, giving up gluten, dairy and sugar. And she learned how to meditate to reduce stress. All these changes, she says, have made a huge difference. She has far fewer headaches and when she does have them, they’re far less severe. “I’m finally healing,” she says.


Rating

2 Star

Categories

NPR

For Headaches, A Lifestyle Change May Be Better Than A Doctor Visit

Our Review Summary

There are many bold statements made in this story about the single patient that is the focus of the piece and about the efficacy of different treatments for migraines. Yet no evidence is analyzed or presented to back up these claims. The person with severe migraines is presented here as a pitiable character experiencing extreme pain and resistant to all efforts at treatment. She eventually finds help through dietary changes and exercise, but we’re not offered any proof, beyond the story’s assurance and an expert’s opinion, that such changes have been shown to be broadly effective for people with migraines. The story does include a discussion of the harms caused by too much diagnostic testing in people with headaches that was very valuable. But the message about treatment is not nearly as strong as it could have been with support from real evidence.

 

Why This Matters

Many people suffer from chronic headache. It interferes with jobs, relationships, quality of life, and adds to healthcare costs.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Costs are not discussed in any way, either for the treatments that the woman at the heart of this story ostensibly underwent or the handful of alternatives tossed in at the end of the story.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

When you first read the headline of this story — “For Headaches, A Lifestyle Change May Be Better Than A Doctor Visit” — you assume that it will show you evidence of lifestyle changes improving a significant number of people’s lives where medicine has failed. The story does not do that. It provides no quantification of the benefits of lifestyle changes and, in fact, does not even mention them until the final two paragraphs of the story.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

A strong point of this story is that it does explore the potential harm from unnecessary diagnostic tests. We applaud the mention, as too few stories address this phenomenon, but the facts that are presented to help the audience understand why a test would be harmful are somewhat confusing. The story says:

Mafi’s study did not include patients with tumors or other serious problems that can cause headaches. He only looked at otherwise healthy patients who suffered chronic headaches. And in these cases, repeated diagnostic testing can lead to further unnecessary procedures like biopsies. On top of that, exposure to radiation in tests like CT scans adds up over time and can increase the risk of certain cancers.

In other words, diagnostic tests could find something like a tumor that is causing a headache or early bleeding in the brain prior to an aneurysm, for example. But those people weren’t part of this study so we have no way to make a true comparison to people who had a test and found a problem versus people who had an unnecessary test.

The story should have explained the exclusion of patients with tumors more clearly. The patients here are chronic headache patients, as opposed to people who have developed headache as a new symptom or a new type of headache. Depending on their presentation, the latter two may need a series of tests.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The entire story is framed by the idea that more and more people are being diagnosed with migraine headaches and are likely receiving unnecessary and potentially harmful tests. The clinicians are presented in this story as experts in migraines and migraine treatment. In one case, a study about diagnostic tests is referenced with no examination of the quality of that study. How many people? Under what conditions? Were the findings published in a peer reviewed journal? In the other case, the story presents as fact that patients are changing their diets or exercising more and seeing their migraines go away. The story says:

Some people find relief through exercise. “I write an exercise prescription probably as often as I write a prescription for medication,” Bernstein says. She acknowledges it’s sometimes difficult to encourage a patient with cracking head pain to get up and exercise. But even a little can help, and according to Bernstein it doesn’t have to be jogging for miles and miles. It can be yoga, tai chi or even just a little stretching.

The story is implying that “just a little stretching” is just as effective at reducing migraines as medication. Maybe it is, but we aren’t provided enough information about how this evidence was analyzed to make that judgment.

Does the story commit disease-mongering?

Not Satisfactory

We’re flagging the story for several problems that collectively rise to the level of Not Satisfactory:

1. The narrow focus on one patient’s extreme experience with migraines compared to the lack of focus on any meaningful evidence about how to relieve migraine symptoms.

2. The extrapolation of this one patient’s experience to “12 million Americans” and then to “one quarter of the population,” which would be about 80 million people. This seems high, and there is no reference provided for the number.

3. The anecdotal evidence presented as fact without any attempt to back it up. The story says:

Over the years, Bradford, who is 50 years old and lives in Bedford, Mass., has searched desperately for pain relief. She’s been to the doctor countless times for countless tests. “Everything I’ve had, I’ve had twice,” she says. “I’ve had two spinal taps; I’ve had so many nerve blocks I’ve lost count.”

Has she really been to the doctor so many times that it is impossible to count? This feels needlessly dramatic. Perhaps a walk through the woman’s documented medical history would have supported the same point without that feeling of over-dramatization. Even well-meaning people can provide misleading information about their own medical histories, especially if a condition has been ongoing for years.

Those three components make this story feel off-kilter, and take the focus off of the thoughtful exploration of potential solutions.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

It’s not clear whether either of the clinical sources in this story have any conflicts of interest or particular agendas. But in both cases they are commenting on areas where they couldn’t be considered objective. In one case, the source discusses a study that he coauthored, and in the other case, the source discusses the treatment of one of her patients. We’ll give the benefit of the doubt, because the second source speaks mainly about headaches in general rather than the patient discussed in the story. Ideally, a completely independent expert would have been tapped to question and evaluate the evidence presented.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story mentions alternatives to medical or surgical treatment in the last two paragraphs of the story but it does not explain the relative benefits or harms of any approach.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

If the concept is that lifestyle changes are effective at treating migraines, then it is assumed that people can change their diets or exercise more no matter where they live. The story supports that impression, and we’ll award a satisfactory on that basis. For extra credit, the story could have elaborated on why it was so hard for the woman in this story to find a doctor to prescribe this kind of therapy. Are doctors who embrace this approach difficult to locate? If these approaches are effective, why aren’t they more widely used?

Does the story establish the true novelty of the approach?

Not Satisfactory

Studies and articles documenting over-use of tests and their lack of benefit for specific diseases are still few in number. However, the story does not establish that fact or address the novelty of this line of research. Nor does it establish that the evidence presented about the efficacy of lifestyle changes for treating migraines is or isn’t novel.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not rely on a news release.

Total Score: 4 of 10 Satisfactory

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