Managing migraine in pregnancyBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k80 (Published 25 January 2018) Cite this as: BMJ 2018;360:k80
All rapid responses
Migraine is not a drug deficiency disease but a warning symptom
Professional UK guidelines and resources on headache from the Scottish Intercollegiate Guidelines, the Network National Institute of Health and Care Excellence and the National Institute of Health and Care Excellence are quoted by Jarvis and colleagues. Migraine is not a drug deficiency disease. It is wrong that potentially dangerous medications such as antidepressants, betablockers and aspirin are still being given to pregnant women during pregnancy to prevent headaches. Adding drugs without diagnosing and correcting common underlying biochemical perturbations, which are potentially harmful to both mother and child, is very unfortunate.
In 2006 I wrote in a BMJ Rapid Response to Peter Goadsby ‘s Clinical Review that the evidence of causes and drug free prevention of migraine had been ignored for the past three decades
1 Migraine is not a drug deficiency disease but a warning symptom Re: Recent advances in the diagnosis and management of migraine. Goadsby P. BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7532.25
Professor Goadsby acknowledges financial support from 10 pharmaceutical companies in his review of the management of migraine.1 He lists numerous pharmaceuticals with unpleasant side-effects in a table of preventative treatments. Also both ergot and oestrogen are still being listed as migraine treatments or preventatives. The evidence is overwhelming that use of ergot, oestrogens and progestogens are the main causes of severe and frequent migraines in women and why more women attend acute migraine clinics than men.2,3 Why is this clear cut evidence still being ignored after three decades?
Headaches and migraine attacks warn of disturbed biochemistry. Both zinc and magnesium deficiencies commonly disrupt amine pathways and interfere with normal reactions to stress which results in headaches.4
The avoidance of ergot medications, progestogens and oestrogens and smoking gave a 10-fold reduction in migraine attacks.3 Further avoidance of common dietary migraine precipitants, including alcoholic drinks, resulted in 85% of 60 migraine patients having no further attacks and no patient needed so-called “preventative pharmaceuticals”.5
1 Goadsby PJ. Recent advances in the diagnosis and management of migraine. BMJ 2006;332:25-29 (7 January), doi:10.1136/bmj.332.7532.25
2 Grant ECG, Albuquerque M, Steiner TJ, Rose FC. Oral contraceptives, smoking and ergotamine in migraine. In Current Concepts in Migraine Research. Ed. Greene R. Raven Press, New York 1978 pp 97-100.
3 Grant ECG. Oral contraceptives, smoking, migraine and food allergies. Lancet 1978; 2: 581-2.
4 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity and mineral imbalance. J Nutr Environ Med 1998; 8: 105-116.
5 Grant ECG. Food allergies and migraine. Lancet 1979; 1: 966-69.
2 In 2004 the work of Professor John Soothill in children had been unfairly described as “controversial” in his BMJ Obituary. I also wrote in 2004 that the work of Professor John Soothill in children had been, in my opinion, unfairly described as “controversial” in his Obituary.
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7478.1347 (Published 02 December 2004)
Migraine and hyperactivity in children Re Obituary to John Soothill. Caroline Richmond writes that Professor Soothill’s work on migraine and hyperactivity was controversial. I visited Professor Soothill at Great Ormond Street Children’s Hospital after I had published “Food allergy and migraine” in the Lancet in 1979.1 He was very interested and said he was keen to set up double-blind controlled trials (DBCTs). I said stopping ergot medications, contraceptive or menopausal hormones and smoking, each reduced the frequency of migraine in adults ten-fold. 2 This needed to be done first before exclusion and re-introduction diets were started but could not be included in double-blind randomised controlled trials for obvious reasons. He thought it would be easier to set up trials in children.
Soothill’s trial found that milk, wheat, orange, eggs and chocolate were common food triggers of migraine in children, just as I had found in adults.3 I still have not the slightest idea what is controversial about this work. All similar studies in children and adults with a range of conditions, including hyperactivity, achieve similar results.4.5 Why are important results which are the foundation of very useful preventative treatment slighted?
1 Grant ECG. Food allergies in migraine. Lancet 1979; 1: 966-9.
2 Grant ECG. Oral contraceptives, smoking, migraine and food allergies. Lancet 1978;2:581-2.
3 Egger J, Carter CM, Wilson J, et al. Is migraine food allergy? A double blind controlled trial of an oligoantigenic diet treatment. Lancet 1983: 2: 865-9.
4 Anthony H, Birtwhistle S, Eaton K, Maberley J. Food allergy intolerance investigation and management. In Environmental Medicine in Clinical Practice, 1997 BSAENM Publications, Southampton: pp 106-140.
5 Egger J, Graham PJ, Carter CM, et al. Controlled trial of oligoantigenic treatment in the hyperkinetic treatment. Lancet 1985; 1:540-5.
It is now four decades since I published Food Allergies and Migraine in the Lancet in 1979 proving that patients with the most severe and frequent migraine attacks attending Charing Cross Hospital Migraine Clinic could be made headache and medication free using Dr John Mansfield’s exclusion and re-introduction diet after stopping all medications. Why is reality taking so long to be accepted?
Competing interests: No competing interests