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Migraine: NICE recommends further prevention option

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4052 (Published 19 October 2020) Cite this as: BMJ 2020;371:m4052

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Avoid precipitants Re: Migraine: NICE recommends further prevention option

Dear Editor

Avoid precipitants Re: Migraine: NICE recommends further prevention option

Is NICE not concerned that the 12 country CONQUER trial of Galcanezumab, a humanized monoclonal antibody costing £5000 a year for treating episodic or chronic migraine attacks, found an equal number of adverse events (including an equal number of serious adverse effects) in the 232 treated and 230 placebo participants? [1] This finding should suggest that the underlying causes of the migraine attacks or cluster headaches had not been dealt with in the first place.

In my experience, headaches and migraine arracks are warning signs of vascular over-reactivity to common precipitants. Migraine affects three times more women than men because of women’s use of contraceptive or menopausal progestogens and oestrogens. Charing Cross Hospital migraine patients who avoided ergot medications, contraceptive or HRT progestogens and oestrogens, and/or smoking, each had a 10-fold reduction in migraine attacks. [2] Also, 60 migraine patients, who still had headaches, completed Dr John Mansfield’s high protein low allergy elimination and reintroduction dieting after a 5-day period of withdrawal from their usual diet, medications and social habits. Previous oral contraceptive, tobacco, and/or ergotamine use averaged 3 years, 22 years, and 7.4 years respectively. [3] Only lamb and pears and spring water from glass bottles was consumed for 5 days before one food per meal was introduced three times daily.

The commonest foods causing reactions (mostly increase in pulse rate or blood pressure), were wheat (78%), orange (65%), eggs (45%), tea and coffee (40% each), chocolate and milk (37% each), beef (35%), and corn, cane sugar, and yeast (33% each). Avoiding an average of ten common foods resulted in a dramatic fall in the number of headaches per month, with 85% of patients becoming headache-free and all the patients with hypertension becoming normotensive. An average of 115 tablets were taken per month before the diet but afterwards only an average of 0.5 tablets were used.

Why is the clear and overwhelming evidence that “migraine is not a drug deficiency disease” still being ignored over the past four decades? Is the method above too cheap or just too time consuming?

1 National Institute for Health and Care Excellence. Final appraisal document: galcanezumab for preventing migraine. 15 Oct 2020. https://www.nice.org.uk/guidance/gid-ta10454/documents/final-appraisal-d....
2 Mulleners WM, Kim BK, Láinez MJA, et al. Safety and efficacy of galcanezumab in patients for whom previous migraine medication from two to four categories had failed (CONQUER): a multicentre, randomised, double-blind, placebo-controlled, phase 3b trial. Lancet Neurol2020;19:814-25. doi:10.1016/S1474-4422(20)30279-9 pmid:32949542.
3 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med 1998;8:105-116.
4 Grant ECG. Oral contraceptives, smoking, migraine and food allergies. Lancet 1978;2:581-582.
5 Grant ECG. Food allergies and migraine. Lancet 1979;1:966-969.

Competing interests: No competing interests

27 October 2020
Ellen CG Grant
Physician and medical gynaecologist
Retired
Kingston-upon-Thames, Surrey, UK