This story advances the claims of a book author/ear, nose and throat surgeon who says that many patients with migraines actually suffer from migraine-like headaches caused by a deviated septum in the nose. While the idea sounds reasonable enough, what’s lacking here is evidence. Most problematic is that the story unquestioningly passes along the author’s claim — based entirely on his own practice data — that he has a 90% success rate when treating headache patients with deviated septums. That’s a statistic that will probably help sell lots of books and drive more patients to the author’s practice, but we doubt it accurately reflects the benefits that the typical patient can expect from this treatment. Also troubling is the story’s failure to mention any possible harms associated with the surgery promoted in the book. Considering that septoplasty itself can provoke new chronic pain in some patients, this omission is particularly glaring.
Migraine headaches can have a huge impact on people who suffer with them and these patients may seek out multiple treatments in the hope of finding some relief. When evaluating these therapies, journalists need to go beyond sources who stand to gain financially from promoting them, including book authors. The most important question to keep in mind is: Where is the evidence that they work?
While the story does mention costs, it does so in a superficial and potentially misleading way. First, any useful discussion of costs would have to include information about the costs of the CT scanning and surgery – costs t hat are not mentioned in the article. Second, claims that the book author’s approach is "cost-saving" are non-sensical given that the treatment implied by the article includes an MRI and referral to a specialist or two. Such profligate and unsupported waste of society’s resources flies in the face of claims of "cost-savings."
The story relies entirely on Dr. Smith’s assertion that 90% of patients experience relief after repair of a deviated septum. But important questions remain unexplored. For example: How many patients are we talking about here — two or two hundred? And: How does Dr. Smith define "relief" — total absence of headaches or merely reduced headache frequency/intensity? In addition: What percentage of migraine-like headache sufferers are diagnosed with a deviated septum and would be candidates for surgery? And finally: How does septoplasty stack up against other forms of treatment or no treatment in controlled studies?
We think that by failing to challenge in any way Dr. Smith’s estimate of a 90% success rate, readers are likely to come away with an exaggerated view of what this treatment can do for the average patient.
The story mentions no potential harms from septoplasty or from CT scanning. This is a major error considering that some patients develop new chronic pain from the surgery itself and are left with daily intrusive pain. The surgery on balance may be harmful, especially if performed poorly or on the wrong patients, the incidence of the latter being likely to rise if many people read the book or this article. There also is growing evidence that unnecessary CT scans increase the risk of cancer.
There was no evidence presented in this story beyond the anecdotal impressions of the book author, Dr. Smith. Smith says that in his experience, "some 90 percent" of patients have gotten headache relief after a deviated septum is repaired. But we can’t really tell if this is a ballpark guesstimate or a carefully conducted analysis of his practice statistics. If the latter, we might reasonably expect some discussion of how they selected patients, how the study was designed, whether there was a control group, or if any blinding or randomization was used. But the story provides none of these things. At the very least, the story should have cautioned that a case series from a single practice constitutes a very shaky evidence base, but again, it didn’t.
Some problems here: Migraine headache is not defined in this article. In fact, the opening line is terribly vague: "If you suffer from chronic or migraine headaches…." The word "migraine" implies to many readers that there is something special about the head pain the word describes. Migraine represents a small proportion of all head pain, and migraine that cannot be managed adequately without lifestyle changes or medications are rarer still. The reader of this article might assume their head pain is what the author is talking about, and it seems unlikely. Conversely, sinus pain is common, often easily diagnosed, and responds to many treatments. The article implies that MRI and referral to a neurologist are standard treatments for "migraine." Thankfully, this is not the case. Many people with head pain and /or migraine headache do very well without such interventions.
Anyone with a book to promote is clearly going to have a strong financial incentive to advance their own interpretation of the evidence. And while this story did include a comment from one outside expert, presumably a radiologist, in this case the issue demanded some perspective from an expert on migraines– e.g. a neurologist or other pain specialist. This story didn’t provide that.
This story didn’t mention any other approaches to treating migraines that don’t respond to initial therapy.
The availability of surgery to correct a deviated septum is not in question, so we’ll rule this one not applicable.
There’s nothing new here that merits a book or even a newspaper article. It is standard — repeat, standard — practice to rule out sinus conditions such as a deviated septum in the evaluation of persistent head pain.
Although the story bears some similarity to a press release put out by Dr. Smith’s book publisher, we didn’t find any copy that was directly lifted from the press release. Since we can’t be sure to what extent the story relied on this release, we’ll rule it not applicable.