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BMJ 2005; 330 doi: (Published 10 February 2005) Cite this as: BMJ 2005;330:346

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Causes of headache

Bal and Hollingworth do not specify the main causes of increasingly frequent and severe headaches in a 32 year-old woman.1 These are use of hormonal contraceptives or ergotamine medication or tobacco smoking, as I detailed in a response to Tim Steiner's review.2

Was the young woman taking hormones? Was she at risk of becoming pregnant? As no contraceptive method is 100% effective, ergot and most medications are inappropriate for women of reproductive age. Ergot medications are the main cause of severe recurrent headaches with nausea and vomiting. Which complementary medicines cause headaches? Herbs with oestrogenic actions or herbs contaminated with mycotoxins would be suspect particularly.

Nearly all migraine patients believe their headaches are due to stress but very common deficiencies in intracellular zinc and/or magnesium concentrations impair amine metabolism and the ability to have flexible biochemical responses to stress. These deficiencies impair the function of hundreds of enzymes and increase headache reactions to common foods like wheat and coffee and common chemicals like tobacco smoke and domestic gas.3,4

I have been amazed that stroke medicine doctors are involved in research to find out if HRT can "prevent" strokes decades after we had evidence that progesterones and oestrogens caused strokes.5,6 Our first paper finding that oral contraceptive use increased headaches and migraine was published by the BMJ in 1962.7 The 3rd woman enrolled in the Anovlar study developed benign intracranial hypertension and the 12th woman had a thrombotic stroke with secondary haemorrhage after 5 years.3 In 1977 the RCGP oral contraceptive study reported a 4.1 times increased risk of cerebo-vascular accidents (CVA) in oral contraceptive users in 1974 and a 2.7 times increased CVA mortality with 10 years of use in 1999.

Iain Chalmers believes researchers should first analyse what can be learned from existing research and that it is unethical to ignore previous work. Past evidence is still being ignored in the continued promotion of hormone use and in the management of headaches.

1 Bal S K, Hollingworth GR. Headache BMJ 2005; 330: 346 (12 February), doi:10.1136/bmj.330.7487.346

2 Grant ECG. Clinical review of headache, 27 Oct 2002

3 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med 1998; 8:105-16.

4 Grant ECG. Reducing the cost of headaches, 26 Mar 2004

5 Grant ECG. HRT, strokes and vasodilatation, 27 Jan 2005

6 Grant ECG. Hormonal contraceptives cause migraine, ischaemic and haemorrhagic strokes., 13 Jan 2005

7 Mears E, Grant ECG. "Anovlar" as an oral contraceptive. BMJ 1962; 2: 75-79.

Competing interests: None declared

Competing interests: No competing interests

14 February 2005
Ellen C G Grant
physician and medical gynaecologist
Kingston-upon-Thames, KT2 7JU