Wagner’s migraine and other stories . . .

Cluster headache is the prosaic name given to a dramatic and intensely painful condition. Fortunately, breathing in pure oxygen usually provides a rapid escape from its agonies. But just as we don’t understand what causes this periodic syndrome, with its localised autonomic symptoms of unilateral flushing and lachrymation, neither do we know why oxygen treatment works. An excellent meta-analysis in Cephalalgia (2014, doi:10.1177/0333102414529672) dates the first use of oxygen for severe headache to 1940, although it was not commonly used for cluster headache until the 1980s. An oxygen delivery rate of 6-7 L/min seems to work for most attacks, but some people need ≥12 L/min.

Public health physicians, chief medical officers, health visitors, and counsellors share a keen sense of the innate sinfulness of humankind. People seldom change their behaviour. But just occasionally an intensive lifestyle intervention can actually be shown to work; and even more rarely it can be shown to affect real outcomes. In Da Qing, China, 28 years ago, 577 adults …