Headaches

Sometimes I get headaches.  Doesn’t everyone?  I always get weirded out by the checkbox on those medical history forms they always want you to get there early to fill out.  Shouldn’t they be asking about frequency of headaches?  Maybe some people have never experienced a headache.  “What, you mean like when I grab a towel from the cupboard over the sink and forget to close the door and bang my head on it and it hurts?”  Yeah.  Like that.  I guess.

I think frequency is correlated with stress.  Stress leads to procrastination, procrastination leads to blogging, blogging leads to… where was I going with this?  Oh, right!  An email newsletter on treating headaches with acupuncture, which I will now brazenly quote without context or permission:

Two separate systematic reviews by Cochrane Researchers show that acupuncture is an effective treatment for prevention of headaches and migraines.

In each study, the researchers tried to establish whether acupuncture could reduce the occurrence of headaches. One study focused on mild to moderate but frequent “tension-type” headaches, whilst the other focused on more severe but less frequent headaches usually termed migraines. Together the two studies included 33 trials, involving a total of 6,736 patients.

Overall, following a course of at least eight weeks, patients treated with acupuncture suffered fewer headaches compared to those who were given only pain killers. In the migraine study, acupuncture was superior to proven prophylactic drug treatments.

In one specific study involving 270 patients, acupuncture cut tension headache rates almost in half. Researchers divided the patients who reported similarly severe tension headaches into three groups for the study. Over the project’s eight-week period, one group received traditional acupuncture, one received only minimal acupuncture (needles inserted at non-acupuncture points, and at only shallow levels), and the third group received no treatment.

Those receiving the traditional acupuncture reported headache rates of nearly half that of those who received no treatments, suffering 7 fewer days of headaches. The minimal acupuncture group suffered 6.6 fewer days, and the non-acupuncture group suffered 1.5 fewer days. When they received acupuncture after the main study period, the “no treatment” group also reported significantly fewer headache days.

The improvements continued for months after the treatments were concluded, rising slightly as time went on.

Sources:
British Medical Journal, July 2005
Acupuncture for tension-type headache. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD007587 DOI: 10.1002/14651858.CD007587
Acupuncture for migraine prophylaxis. Cochrane Database of Systematic Reviews, 2009, Issue 1. Art.No.: CD001218 DOI: 10.1002/14651858.CD001218.pub2

If you get regular headaches, please call for a consultation today.

[Boldface and lack of hyperlinks in the original.]

Now, I’m supposed to be doing something productive right now, so my priority is to act on this immediately.  Sure enough, here’s the British Medical Journal article about the “one specific study” from which those factoids were extracted (published in July 2005, as promised, though BMJ turns out to be weekly — who knew?), and here are the two Cochrane meta-analyses on tension headaches and migraines, respectively.  And when I say “here’s the article” and “here’s the meta-analysis,” what I really mean is “here’s the abstract.”  You don’t expect me to actually read the papers, do you?  What, just because I’m avoiding work, I should try to evaluate their methodology?  No thanks!

[Fun fact: Although the not-for-profit Cochrane Collaboration’s papers are only available to paid subscribers — simply complete the free registration process and accept the terms of use to see prices! — it is perfectly legal for a member of the general public to BART over to Doe Library with a Flash drive and take full advantage of the University of California’s extensive institutional subscriptions.  Provided, of course, that you don’t let just anyone get their hands on the perfectly legal contents of your Flash drive!  That would almost certainly be a crime.]

Lucky for me, I don’t even need to click through to the free PDF of the BMJ article on tension headaches to get this juicy sound bite:

Results The number of days with headache decreased by 7.2 (SD 6.5) days in the acupuncture group compared with 6.6 (SD 6.0) days in the minimal acupuncture group and 1.5 (SD 3.7) days in the waiting list group (difference: acupuncture v minimal acupuncture, 0.6 days, 95% confidence interval -1.5 to 2.6 days, P=0.58; acupuncture v waiting list, 5.7 days, 3.9 to 7.5 days, P<0.001).

In other words, according to this particular cherry-picked study, acupuncture is almost certainly quite a bit better than nothing.  (The meta-analyses agree.)  But it doesn’t seem to work significantly better than anything else, including placebo (or “sham” treatment, as one of the meta-analyses aptly puts it — this is where they pretend to give you acupuncture, taking care to do it in all the wrong places, pressing hard enough that you notice the needles but not hard enough to go all the way through your skin).

[This is just one study, mind you.  The tension headache meta-analysis found “[s]mall but statistically significant benefits of acupuncture over sham,” contradicting my conclusion.  The migraine meta-analysis mostly agrees with me but then goes on to wonder whether the pretend acupuncture was too realistic.  What if it turns out that real acupuncture and pretend acupuncture are both better than some other, more placebo-ish placebo?  An excellent question for advocates of both real and fake acupuncture to consider!]

In fact, for some of these headaches (certain migraines, say), there might well be no known treatment that works better than placebo!  And, hey, acupuncture has fewer side effects than Tylenol or caffeine or other similarly-questionable cures.

[Again, this is what’s known as an “uninformed opinion,” meaning “I don’t really know what I’m talking about.”  But I really do believe what I’m saying!  It feels right to me, you know?  Sure, I could be all wrong, and I accept that, but I do have an opinion.]

Now, imagine you’re a researcher, and you’ve somehow arrived at similar conclusions — privately, at least — which, unlike me, you’re in a position to defend with well-reasoned arguments and hard evidence, if need be.  Acupuncture: better than nothing, just as as drugs (with fewer side effects!), but no better than placebo.  For the sake of argument, if nothing else.

It’s sort of a tricky situation, isn’t it?  I mean, what would you recommend that headache sufferers do?

Well… acupuncture, right?  It’s the best available treatment!  Duh!

But it’s kind of weird to just come out and say, “Yeah, turns out acupuncture totally works,” or even to let the press to quote you saying that (and you know that’s going to be the sound bite, even if you spend the rest of the day hemming and hawing), because that statement kind of misses the point, doesn’t it?  In fact, it looks a lot like there is nothing special about acupuncture at all!  So coming out and endorsing it specifically feels sort of like endorsing snake oil (or JC Tonic, or bottled water) on the strength of the fact that many of the people who buy into it are seeing real, quantifiable benefits.  Which is presumably the case, right?  But, I mean, hey, I don’t know for sure.  I haven’t heard of any studies.  Which I guess means I can’t actually recommend bottled water as a headache remedy, even if it might be equally effective and, you know, cheaper than fake acupuncture.

Or can I?  For, like, the benefit of humanity?  What if I did a study, and the results turned out to support my agenda, and I somehow convinced all the bottled-water companies to plaster them all over all water bottles everywhere?  Even with all that, would anyone even listen to my message?

Now, acupuncturists are not scammers — they’re not malicious, and they don’t seem to be doing any unintentional harm either (another point of general agreement).  Well, I mean, sure, there must be malicious and/or harmful acupuncture out there somewhere, genuine or otherwise.  You can say the same of almost anything, right?  So does it really make sense to accord much weight to that fear?

It’s important to be objective about this.  We’re scientists.  We can’t let ourselves be influenced by our “emotions” and our “gut feelings” and our “values,” just because we “know them in our hearts to be true!”  Can you imagine trying to get such a flimsy justification published in a reputable journal?  You’d be the laughingstock of your peer review group!  All that touchy-feely stuff is seriously unseemly and uncool and unmanly — er — unquantifiable, is what I mean!  Can’t be measured, you know.  Unless you’re a “social scientist,” of course… but those are “soft” sciences, and we’d much rather think of ourselves as “hard” scientists, wouldn’t you say?  Gotta stay reductionist, here.  Reality is complicated.  It isn’t our place to try to consider all possible variables at once.  That way lies madness and despair.  Focus!  Be systematic.  Divide and conquer.  It’s our only hope for progress and salvation!

Turns out that, as a scientist, you’re not supposed to make a recommendation.  You’re supposed to state the facts in mind-numbing detail, toss it over the wall, and let whoever happens to find it (if anyone) draw his or her own conclusions about the larger implications (if any).  There is no “tricky situation” here.  These are not the droids you’re looking for.  This is science.

Now, the same goes for journalism, right?  Be objective, state the facts, give both sides of the argument, and let people form their own opinions instead of stating yours as if they were, you know, true or something.  You want the truth?  The truth is that your readers don’t want your opinion.  They don’t care!  Who do you think you are, some kind of domain expert rocket scientist?  You don’t know what you’re talking about.  Even if you did, there’s no need to spoon-feed them predigested conclusions!  Don’t be so cynical.  People are smart.  Trust your audience!  Just give them all the facts.  They’ll figure it out somehow.

(And no, for the last time, you may not print the DOI number of the original study in your article!  This is a newspaper!  We have standards to uphold!)

So, um, anyway.

Do you suppose it’s realistic of me to expect significant improvement in my headaches if I were to spring for eight weeks of acupuncture, or whatever it was?  Best available treatment, right?  Or weasel words to that effect?

Does it matter if I’m initially skeptical about the efficacy of the treatment?  Did any of those studies control for that?

Don’t even make me ride BART to find out.  I have important work I need to be doing right now, I’m stressing out about it, and for some reason I keep falling further and further behind schedule….

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