Talk:Migraine/Archive 4

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NPOV at alternative therapy section

Chiropractic manipulation, physiotherapy, massage and relaxation might be as effective as propranolol or topiramate in the prevention of migraine headaches; however, the research had some problems with methodology.[71] The evidence to support spinal manipulation is poor and insufficient to support its use.[72]

The proposed text was "spinal manipulation may be as effective as propranolol or topirate [71][72]. This removes the editorializing put into the current texts "some of the problems with methodology" meanwhile the final sentence states the evidence is poor and insufficient". This is misleading and creates POV problems. Please discuss. DVMt (talk) 20:25, 2 March 2013 (UTC)

Both the sources in question comment on the issues with the research base. This ref states "However, the evaluated RCTs had many methodological shortcomings" [1] and this ref states "Their methodological quality was mostly poor and ranged between 1 and 3 on the Jadad scale." followed by "Current evidence does not support the use of spinal manipulations for the treatment for migraine headaches." [2] Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:38, 2 March 2013 (UTC)

One source demonstrates effectiveness, one does not. Hence the 'may be'. If it's the standard to get into detailed analysis for each reference than it should apply to all migraine related research not just complementary med. DVMt (talk) 20:40, 2 March 2013 (UTC)

Both refs agree the quality of the evidence is poor. Lets wait and see what others may think. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:48, 2 March 2013 (UTC)

They both do not agree the evidence is "poor". This is misleading the readers. Only the skeptical review states that. Back on point "spinal manipulation may be as effective as propranolol or topirate however more research is needed to address possible methodological flaws". That seems to address both our concerns, NPOV style. DVMt (talk) 20:53, 2 March 2013 (UTC)

We will have to agree to disagree again. To me "However, the evaluated RCTs had many methodological shortcomings" is not a statement that the conclusions are conclusive as the research base is excellent. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:56, 2 March 2013 (UTC)

I'm sorry I can't follow your point. What is the conclusion you want to state? The most neutral way of discussing a supportive and dissenting review re; effectiveness is to qualify the statement "may be" then list both sources. I don't see why it has to be much more complicated than that. DVMt (talk) 21:05, 2 March 2013 (UTC)

Comment I think the MOS states that phrases like "however more research is needed to address possible methodological flaws" are undesirable... Lesion (talk) 21:11, 2 March 2013 (UTC)

I agree they're undesirable but Doc James had concerns about the quality of the research and then mischaracterized it as "poor" which I objected to. The statement ""spinal manipulation may be as effective as propranolol or topirate [71][72]." is all we need. DVMt (talk) 21:15, 2 March 2013 (UTC)

Agree we typically never say more research is needed as one could say that after nearly every line. The fact that the evidence base is poor is something we often comment on. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:16, 2 March 2013 (UTC)

Suggest direct quoting of best available sources to solve this disagreement over wording? Lesion (talk) 21:18, 2 March 2013 (UTC)

Direct quotes are discouraged. Typically we paraphrase. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:20, 2 March 2013 (UTC)

...or a much closer paraphrase? Lesion (talk) 21:22, 2 March 2013 (UTC)

The ref says "Their methodological quality was mostly poor... Current evidence does not support the use of spinal manipulations for the treatment for migraine headaches." and this has been paraphrased as " The evidence to support spinal manipulation is poor and insufficient to support its use."[3] Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:25, 2 March 2013 (UTC)

The use of such words and phrases as "inconclusive," "more research is needed," etc. is a red flag that the matter is so unsettled that we probably shouldn't be drawing any conclusions at all, especially adding clear OR like "may." Just cite the source. -- Brangifer (talk) 21:30, 2 March 2013 (UTC)

I agree with Lesion. The scientific consensus is not that the research is "poor" merely the outlier, skeptical Ernst/Posadzki states this. I will note that our disagreements always center around the POV push for Ernst/Posadzki to get more weight and skewer the mainstream view. Clearly you are a skeptic, but we must not let our personal practice preferences/opinions to obfuscate the what the mainstream med consensus is stating. Ernst and Posadzki aren't part of that consensus, granted, but consensus does not require unanimity. The text should read plainly and simply """spinal manipulation may be as effective as propranolol or topirate [71][72]." Use both sources and it doesn't outweigh one or the other and, most importantly, does insert personal POV that the research is "poor". DVMt (talk) 21:32, 2 March 2013 (UTC)

You agree with Lesion on what? And yes we are using Ernst and Posadzki and no they are not outliers. The refs clearly state that the research is poor so this is not a personal POV. But DVMt if you want to suggest a change maybe try a RfC. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:36, 2 March 2013 (UTC)

This source found RCTs that suggest manipulation is as effective as common migraine drugs; however, the RCTs had shortcomings, so the authors qualified their conclusions with "might be as effective...". I think a direct summary of that source, ie: "might be effective for..." is appropriate. The qualifier "might be effective" would also make the text consistent with Ernst critical review, which also suggests that the current research is insufficient to make bolder claims. Thus, I 'vote' for saying "Spinal manipulation might be as effective as....for the treatment of migraine" and sourcing both systematic reviews that are available. Puhlaa (talk) 21:47, 2 March 2013 (UTC)

Is this too longwinded to include? "Certain randomized control trials have suggested that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate to prevent migraine, however two subsequent systematic reviews raised concerns over the quality of these studies, with one concluding that evidence does not support the use of spinal manipulations for the treatment for migraine headaches." Lesion (talk) 22:01, 2 March 2013 (UTC)

Yes this is just a summary. Maybe on a subpage dealing with the matter in greater detail? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:05, 2 March 2013 (UTC)

It is long, but it is fair and accurate. If this approach is what gains consensus, I might suggest amending it to says : "A systematic review found that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate to prevent migraine, however a subsequent systematic review raised concerns over the quality of the research and suggested that the evidence does not support the use of spinal manipulations for the treatment for migraine headaches."

How many words the same is one allowed to use before concerns of "copy and paste"? I read seven somewhere. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:20, 2 March 2013 (UTC)

Agreed with Puhlaa and Lesion. Spinal manipulation may be equally effective as propranolol and topiramate in the prevention of migraines". That's equal weight for the outlier source. DVMt (talk) 22:33, 2 March 2013 (UTC)

Re. user:Puhlaa's suggested reword, I disagree with this because it suggests that one RV was in favor and the other against. As user:DocJames pointed out, both reviews raise concerns over the quality of the evidence...Re James' comment: yeah maybe it is too much... but I don't think the authors would mind...it is normal to paraphrase important conclusions closely no? My suggested wording could be reduced down more,, and maybe split to 2 sent so it reads better... "A systematic review found that chiropractic spinal manipulative therapy (and other similar physical interventions) might be as effective as propranolol and topiramate to prevent migraine, however both this review and a subsequent systematic review raised concerns over the quality of the research, and the latter concluded that the evidence does not support the use of spinal manipulations for the treatment for migraine headaches." Lesion (talk) 22:35, 2 March 2013 (UTC)

Yes I would be happy with this. And while the authors/publisher may not mind I am very careful about anything that could look even a little like copy and paste. I would also leave in the specific other methods:

"A systematic review found that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative might be as effective as propranolol and topiramate to prevent migraine, however both this review and a subsequent systematic review raised concerns over the quality of the research, and the latter concluded that the evidence does not support the use of spinal manipulations for the treatment for migraine headaches."Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:40, 2 March 2013 (UTC)

Yes, I am in agreement with Lesion's most recent assessment of my suggested reword....I agree with his/her concerns over the false implication that one review was in favour. Lesion's modified proposal is satisfactory IMO.Puhlaa (talk) 22:44, 2 March 2013 (UTC)

Lesion has a good proposal. I agree. Consensus reached? DVMt (talk) 22:59, 2 March 2013 (UTC)

Not quite, copy and paste issue remains. I took out "massage therapy, physiotherapy, relaxation" to try and reduce space only, I also think it is more accurate to specify these. The only part that is still word for word is the last part: "concluded that the evidence does not support the use of spinal manipulations for the treatment for migraine headaches." consider instead "concluded that evidence does not support use of spinal manipulations as a therapy for migraine" slightly better? Lesion (talk) 23:01, 2 March 2013 (UTC)

..."concluded that evidence does not favour the use of spinal manipulation as an intervention for migraine headaches". DVMt (talk) 23:04, 2 March 2013 (UTC)

Sure I am happy with Lesions's proposal "A systematic review found that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative might be as effective as propranolol and topiramate to prevent migraine, however both this review and a subsequent systematic review raised concerns over the quality of the research, and the latter concluded that evidence does not support use of spinal manipulations as a therapy for migraines." Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:13, 2 March 2013 (UTC)

(edit conflict) I think you're quite close to an acceptable wording. When differing conclusions are reached by various reliable sources, our normal practice is to reflect both views as neutrally as possible. It seems that there are two main secondary sources under consideration here and in this case both need to be represented. The key points seem to be:

• the range of treatments considered - massage therapy, physiotherapy, relaxation and chiropractic spinal manipulation
• the equivalence of those with commonly used drugs
• the quality of the primary research
• the lack of evidence that supports the use of spinal manipulation to treat migraine

It is usual to attribute in these cases - "one review found ... another review concluded ..." is usually sufficient since the detail is in the linked reference - since it turns statements of fact (that may be disputed between sources) into statements of the opinions expressed in reviews. As long as we cover those key points and not express contested views in Wikipedia's voice as undisputed fact, we will have done our best to communicate accurately to the reader the current state of knowledge on this issue. --RexxS (talk) 23:23, 2 March 2013 (UTC)

SM might be as effective as propranolol or topiramate in the prevention of migraine headaches,[13] whereas another review found did not support the use of spinal manipulation for the treatment of migraine headaches.[106] This covers both arguments. Then we can talk about the research methodology in the next sentence. DVMt (talk) 23:28, 2 March 2013 (UTC)

I prefer Lesions's version as findings are not independent of the evidence base. We can put this to RfC if there is continued disagreement. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:31, 2 March 2013 (UTC)

SM might be as effective as propranolol or topiramate in the prevention of migraine headaches,[13] whereas another review found did not support the use of spinal manipulation for the treatment of migraine headaches.[106]. Concerns were raised regarding the methodology of studies. DVMt (talk) 23:33, 2 March 2013 (UTC)

RfC on some aspect of alt med

Proposal 1

It is proposed that we change

Chiropractic manipulation, physiotherapy, massage and relaxation might be as effective as propranolol or topiramate in the prevention of migraine headaches; however, the research had some problems with methodology. The evidence to support spinal manipulation is poor and insufficient to support its use.

to

A systematic review found that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative might be as effective as propranolol and topiramate to prevent migraine, however both this review and a subsequent systematic review raised concerns over the quality of the research, and the latter concluded that evidence does not support use of spinal manipulation as a therapy for migraines.

References

Support

• Support Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:03, 3 March 2013 (UTC)
• Lesion (talk) 15:57, 3 March 2013 (UTC)
• Brangifer (talk) 07:25, 4 March 2013 (UTC)
• Support. This puts the case most clearly as it appears in the sources, and does not make any evaluative independent statements. I prefer this statement to option 3, which was next best. JonRichfield (talk) 07:08, 11 March 2013 (UTC)

Oppose

• DVMt.

Discussion

• This wording most closely follows the wording of the cited sources. Lesion (talk) 15:57, 3 March 2013 (UTC)

Option 2

• RFC comment Per WP:MEDMOS we should try avoid talking about the reviews and just summarize the quality of the evidence and the results. The first review looked at 4 techniques, while Ernst only looked at SMT. Both reviews clearly did not find good or even adequate quality evidence in support of anything. My recommendation:

  There is poor-quality evidence suggesting that massage therapy, physiotherapy and relaxation maybe as effective as propranolol and topiramate in preventing migraines. There is insufficient evidence to support the use of chiropractic manipulative techniques to treat migraines.

  ...sourced as above. Zad68 04:04, 3 March 2013 (UTC)

Support

• Support Yes would be happy with that as well. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:13, 3 March 2013 (UTC)
• Support If you change "maybe" to "may be", and change both instances of "and" to "or". -- Scray (talk) 05:55, 3 March 2013 (UTC)

This would also be a good chance to note the benefits, in terms of clarity, of the Oxford comma (i.e. add one after "physiotherapy"). -- Scray (talk) 05:58, 3 March 2013 (UTC)

• Support. Reasonable. Not watchlisting this page. II | (t - c) 06:22, 3 March 2013 (UTC)
• Support, especially with Scray's grammar fixes. It's clear and concise. Cheers, Dawn Bard (talk) 11:43, 4 March 2013 (UTC)
• Support This seems to be a better version. Minor quibble, shouldn't 'maybe' be 'may be'? I am not an 'A star' guy in English so I could be wrong.--MrADHD | T@1k? 00:01, 18 March 2013 (UTC)

Oppose

• Oppose. I don't have any problems with the substance of the statement, but the wording: "poor-quality" "insufficient" etc are too evaluative (POV?) It might be better if restated as the likes of: "Evidence that... was not supported on review..." and "Reviews concluded that there was insuff..." and so on; statements that can be directly referred to the cited sources. Otherwise I prefer option 1. JonRichfield (talk) 07:08, 11 March 2013 (UTC)

If the reliable sources describe the quality of evidence as "poor" or "inadequate", shouldn't we use those terms here? -- Scray (talk) 07:31, 11 March 2013 (UTC)

No contest, but then it should be made clear which citations were the sources of such assessments. As the wording stands it reads like an assessment by the author of the article text, whether derived from readings or not. Once that is fixed up then I have no problem with this version. JonRichfield (talk) 09:40, 11 March 2013 (UTC)

• Oppose - As per J.R.'s comments immediately above. Snow (talk) 13:30, 18 March 2013 (UTC)

Option 3

• RFC comment.

  A review suggests massage therapy, physiotherapy, relaxation and spinal manipulaton might be as effective as propranolol and topiramate to prevent migraine. Another review concluded no evidence efficacy for spinal manipulation as an intervention for migraine headaches. Both reviews raised concerns suggesting higher quality studies are needed.

  Less weight on the skeptical reviews. The tone is neutral. Also, is the evidence "poor" or is is "low"? DVMt (talk) 04:10, 3 March 2013 (UTC)

Support

Oppose

• Oppose This version is POV and does not reflect the sources fairly.--MrADHD | T@1k? 23:57, 17 March 2013 (UTC)

Option 4

• JonRichfield's query caused me to attempt detailed sourcing of option 2 above, and I found that the descriptors had been reversed in the two statements. I have refactored thus, with references this time:

  A few studies with many methodological shortcomings suggest that massage therapy, spinal manipulation, physiotherapy, or relaxation may be as effective as propranolol or topiramate in preventing migraines. Treatment of migraine using chiropractic manipulative techniques is not supported by available studies, which are poor in quality.

This addresses earlier suggestions that we summarize evidence rather than speaking directly about the reviews, and the language directly reflects the refs. Earlier grammar issues have also been addressed. -- Scray (talk) 12:03, 11 March 2013 (UTC)

• Support. I don't know which of the new proposals the rest of the folk will prefer, but to me this one looks acceptable. JonRichfield (talk) 19:54, 12 March 2013 (UTC)

• Oppose. This is not an accurate portrayal of the literature. The first sentence should include "spinal manipulation". The second sentence is giving undue weight to a skeptic. DVMt (talk) 17:56, 12 March 2013 (UTC)

OK, so add the spinal manipulation. However, I am startled to see that I had misread the second sentence, which to me now seems to be sufficiently ambiguous to need rewording. Pronouns can be very treacherous. Is the intention something more like: "Treatment of migraine using chiropractic manipulative techniques is not supported by a review of available studies, which they assessed as being poor in quality"? That is about what I had thought it was intended to mean, but how about a bit of polishing? JonRichfield (talk) 19:54, 12 March 2013 (UTC)

I have added spinal manipulation to the first sentence. The second source (Ernst/Posadzki) states that SMT is ineffective for the tx of migraine. I support a re-wording of the sentence which could state that "another review did not find effectiveness of spinal manipulation for the treatment of migraines" or something to that effect. Regards, DVMt (talk) 19:59, 12 March 2013 (UTC)

• Weak Support Frankly, the study review itself is so weak in its own empirical certitude and the problems with methodology so obvious, that I'd recommend excising the comment in its entirety (which from current comments seems unlikely to gain traction) or stating that there is no confirmed evidence that these forms of treatment have any efficacy (which seems to be the overwhelming conclusion of the majority of the actual studies), but this of course raises the issue that not all of the various referenced categories of treatment are likely to have identical levels of validation within the research - this is an artifact being preserved by our dependence on the study review, which is not really an ideal source for our purposes here. But in any event, I'm not going to start a proposal 5 (unless I see a lot of people agreeing with my perspective here) so, I'm giving my support for this as the proposed text which most accurately portrays the facts of the research. Snow (talk) 06:47, 17 March 2013 (UTC)

Equally frankly, I am uncomfortable with the situation. I cannot really criticise the desire to include as much relevant, cited material as is available, but meta-studies are generally treacherous to deal with at best, and even the generally calm and courteous exchanges in this discussion have leaned rather towards toleration of weak material. The more we go onto the nitty-gritty though, the more I feel that there is a growing tendency towards handwaving rather than hard evidence. For those who have put a lot of hard work into gathering material, I am not about to heave rocks, but I do urge a bit of a re-think, either of citations or of contexts. Assuming that the works available are valuable as straws in the wind, are they really at present substantial enough to earn their place in the encyclopaedia? Just an itch that I am scratching... JonRichfield (talk) 09:52, 17 March 2013 (UTC)

• Support this one as well. Zad68 01:44, 18 March 2013 (UTC)

Independent review of all proposals

I came here from random RFC request by bot.

Unfortunately I have to conclude that most of the suggested texts misinterpreted the "systematic reviews".

1. Both reviews claimed that they searched medical literature databases for all available publications on the subject.

Facts from Chaibi's review:

1. The review found 7 randomized clinical trials (RCTs) for keywords "migraine chiropractic, manipulative therapy, massage therapy, osteopathic treatment, physiotherapy".
2. These CRTs (not the review itself) claimed the "might be effective".
3. The review found that these CRTs had many methodological shortcomings
4. The review concluded that in order to prove the effectiveness further well-conducted CRTs are required according to the guidelines from the International Headache Society

Facts from Posadzki's review:

1. The review found 3 randomized clinical trials (RCTs) for "spinal manipulations performed by any type of healthcare professional for treating migraine headaches"
2. 2 RCT showed no effects 1 RCT suggested improvement compared to "detuned interferential therapy" whatever it is
3. methodologies of all RCTs were poor.
4. Review's conclusion: no support for "spinal manipulations"

Summary (to be entered into wikipedia article, after editing of style):

As of 2011, there was a small number of reports in English-language publications about RCTs for treating migraine headaches by <.. list the treatments....> Two reviews noted significant methodological shortcomings of most reviewed RCTs and concluded that the available data are insufficient for a firm conclusion about their efficiency.

Please notice the "As of 2011". Tomorrow things will change, but there is no guarantee that wikipedians of tomorrow will bother. Staszek Lem (talk) 17:38, 20 March 2013 (UTC)

In no case the phrase "may be as effective" may be in the wikipedia article. This phrase is an eye-catcher and hence undue weight, in view of inconclusive data (small number of relevant RCTs and nonpositive reviews of them). Staszek Lem (talk) 17:42, 20 March 2013 (UTC)

Sounds reasonable to me. JonRichfield (talk) 19:06, 20 March 2013 (UTC)

• Support Staszek Lem's proposal. It is the most accurate and most NPOV wording I've seen here. Andrew³²⁷ 22:33, 20 March 2013 (UTC)
• Comment While we occasional state the date of the conclusions if we did this for every statement it would become silly. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:58, 20 March 2013 (UTC)
  • Well, there is a thick gray area between silly and misleading. Of course, we would not write "As of 2013 the Earth had a single natural satellite". But in cases like this article I believe the timestamp is warranted. Staszek Lem (talk) 00:52, 21 March 2013 (UTC)
• Support This works quite well compared to other options presented so far here, although I don't know how I feel about the "small number" bit. It's a bit ambiguous, as it either makes it sound like an emerging field (in which case "small number" means "small but sufficient to show interest and significance"), or a purposefully neglected field (in which case "small number" means "not enough to show serious treatment").  — daranz [ t ] 18:31, 24 March 2013 (UTC)

"However, they are believed to be related to a mix of environmental and genetic factors."

Everything related to the body has at least a .1 cause from either environment or genetics. It's called epigenetics. The fact that the above sentence is included in this article twice really brings down the credibility of this article. The sentence effectively says absolutely nothing about the cause. It's like given a list of 100 things, and trying to pick the one correct things out of them, and saying "The thing I need to pick is one of these 100 things." — Preceding unsigned comment added by 24.192.42.242 (talk) 02:18, 21 April 2013 (UTC)

Familial hemiplegic migraine

IMO this detail belongs on the subpage rather than here " a neuronal calcium channel (CACNA1A, FHM1); a glial sodium/potassium pump (ATP1A2, FHM2); and a neuronal sodium channel (SCN1A, FHM3). The fourth is the proline rich transmembrane protein 2 (PRRT2) - an axonal protein associated with the exocytosis complex. Studies of cellular and animal models have shown that mutations in CACNA1A and ATP1A2 facilitate the initiation of cortical spreading depression waves." We should just give a brief summary here. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:50, 28 April 2013 (UTC)

It also seems very similar to this paper "Study of cellular and animal models have shown that mutations in CACNA1A and ATP1A2 facilitated the initiation of cortical spreading depression waves, the mechanism underlying the migraine aura" [4] Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:52, 28 April 2013 (UTC)

Have summarized the content a little further. Each gene is not a disorder so it is not really correct to say a "fifth disorder" thus changed it to another disorder. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:29, 1 May 2013 (UTC)

Paracetamol vs acetaminophen

In line with WP:DRUGGUIDE I have (again) changed the primary references to the drug back to 'paracetamol' (the INN) with 'acetaminophen' (the USAN) in brackets as an alternative name.

Unfortunately some people occasionally change this - please bear in mind that it is primarily North America that uses this name and most over areas use the INN.

Thanks guys! ῤerspeκὖlὖm in ænigmate_(talk)(spy) 12:53, 12 May 2013 (UTC)

Role of vasodilation in migraine headaches

The theory that migraine is a neurovascular disorder and that vasodilation plays an important role is somewhat outdated according to recent research. (Source: http://www.uptodate.com/contents/pathophysiology-clinical-manifestations-and-diagnosis-of-migraine-in-adults).

If someone could double-check and edit this section it would be appreciated! — Preceding unsigned comment added by 132.216.227.56 (talk) 17:17, 18 August 2013 (UTC)

Removed for discussion

I've removed this text[5] added by Ericchevli90 for discussion. Ericchevli90 is a student in Education Program:Case Western Reserve University/ANTH 302 Darwinian Medicine (Fall 2013), the talk page was never tagged with an education course banner, and this is the second time the addition has been removed. The text needs copyediting, it was added to the wrong place with an undue heading, and it is basically a list of links to another student essay page. Please discuss your edits before reading them. SandyGeorgia (Talk) 18:09, 3 December 2013 (UTC)

Evolutionary Explanations

The reason humans are susceptible to migraines is a debated topic. While most commonly fitness-impairing disorders die out due to natural selection, it still remains highly prevalent. Since genetics plays a roll in an individual’s vulnerability to migraines, it is subject to evolution. This evidence supports the belief that migraines provide a survival or reproductive advantage. There are 5 different hypotheses for the evolutionary benefit of migraine headaches.

• Defense mechanism
• Conflicts with other organisms
• Novel environmental factors
• Genetic harms and benefits
• Headache as a design construct

Using a evolutionary medicine perspective, new insight may be provided in the role of migraines. This could further lead to advances in its future treatment and prevention.

Removed from "Devices and surgery" section

I have removed this text inserted by As cefaly for discussion relative to our medical sourcing guidelines and primary unreviewed sources, recentism, Wikipedia is not news, due weight, and potential COI. SandyGeorgia (Talk) 14:52, 11 December 2013 (UTC)

Recently an external cranial neurostimulation technology (Cefaly) - applied at the supraorbital level (superior branch of the trigeminal nerve V1) or at the suboccipital level (major occipital nerve C2) – should allow a larger application of the neurostimulation for migraine treatment and prevention. Many recent studies have demonstrated the safety and the efficacy of Cefaly for migraine treatment.

Yes we need secondary sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:48, 11 December 2013 (UTC)

The Canon of Medicine makes one of the earliest references to headaches caused by perfume odors

The Canon of Medicine, completed in 1025, makes one of the earliest references to headaches caused by perfume odors, a recognized migraine trigger.

In Volume III of The Canon of Medicine, the chapter beginning on p. 298 is titled,

Chapter on treatment of headaches caused by external wind which penetrated into the head

This chapter has two sub-sections:

- on treatment of headache caused by external bad vapors which inflicted the head 298

- On treatment of headache caused by perfume odors 298

http://ddc.aub.edu.lb/projects/saab/avicenna/book-three.html

Hum but was it migraines? I guess we could say "The Canon of Medicine, completed in 1025, makes references to headaches caused by the smell of perfume." Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:57, 10 January 2014 (UTC)

Do perfumes cause other kinds of headache besides migraines?

Could someone able to read medieval Arabic or privy to a translation tell us what these verses had to say on the subject of perfume-triggered headache?

It is not clear if perfume causes migraines but I do not see why not. We should see if we can find a modern source that looks at this. Else what we are doing is sort of original research. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:48, 10 January 2014 (UTC)

Current clinical practice is quite clear that "smells — including perfume, paint thinner, secondhand smoke ..." can trigger migraines. The interesting question is, was that effect already recognized 990 years ago? The Mayo Clinic here gives just one example of the modern full recognition of smells as triggers in some migraineurs:

Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Unusual smells — including perfume, paint thinner, secondhand smoke and others — can trigger migraines in some people. Mayo Clinic: Migraine headache triggers

Mayo clinic is not really a good source. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:49, 2 June 2014 (UTC)

Already mentioned

"Pain is not, however, inherent to migraines. Acephalgic migraine, also known as "silent migraine", is an uncommon variant that does not cause headache." under signs and symptoms and does not pertain to pathophysiology. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:32, 10 July 2014 (UTC)

@Jmh649: It's definitely worth mentioning in the "Pain" section that migraines aren't inherently painful. This is a big article, and a one-sentence mention for that important caveat is definitely worthwhile. Exercisephys (talk) 18:28, 10 July 2014 (UTC)

Lets move from the pain section. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:32, 10 July 2014 (UTC)

We also state in the lead that "Occasionally an aura can occur with little or no headache following it." Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:34, 10 July 2014 (UTC)

Characterized

Does not mean always occurs in. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:24, 10 July 2014 (UTC)

delusions as a symptom

Earlier, my friend posted the fact that migraine can cause delusions and hallucinations. Doc James, a.k.a. user Jmh649, a.k.a. Dr. Heilman, challenged my friend's claim, first when it was unsourced, and then again when my friend used an Oliver Sacks book as a source. Although my friend and I were greatly annoyed by Dr. Heilman's apparent motivation -- that he was objecting to the post merely because he was personally unfamiliar with the fact that migraine can cause delusions and hallucinations -- we in fact had no objective basis for making this accusation, and Dr. Heilman was, indeed, properly interpreting Wikipedia's rules for posting in a medical article. (Also, my friend's resulting comments on the corresponding talk page weren't exactly keeping with Wikipedia's guidelines regarding civility.) Now, we have re-posted the fact about these particular symptoms, because have found sources in what we believe to be respected, peer-reviewed publications, namely The European Journal of Neurology and the Psychiatric Times. True, we are having difficulty with properly formatting the reference, but we have included it. If Dr. Heilman or anyone else still has a problem with our source, please let us know why.

signed, a guest editor — Preceding unsigned comment added by 24.44.178.27 (talk) 15:30, 18 July 2014 (UTC)

This is a case report [6] and the other ref is popular press. Please read WP:MEDRS. We need to use review articles or major textbooks. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:14, 19 July 2014 (UTC)

This book touches on it but only tangentially. [7] Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:17, 19 July 2014 (UTC)

[8] this ref is a little better and I have added it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:22, 19 July 2014 (UTC)

Cause of migraines

This was moved here from User talk:Bestauffer2 Oiyarbepsy (talk) 04:18, 24 October 2014 (UTC)

{{help me}}

http://www.americanmigrainefoundation.org/migraine-research/ This link says that a migraines cause is uknown so in the wiki article about migraines when they say it's a neurovascular disease that is wrong and it needs to be removed

Bestauffer2 (talk) 23:30, 23 October 2014 (UTC)

Actually, if you jump to the section cause, you'll see the first sentence is "The underlying causes of migraines are unknown". So, while it is believed to be neurovascular, we don't really know. I think the article accurately describes the science on the topic and doesn't need revisions. Just in case, I'm moving this to the article's talk page, so the experts there can weigh in. Oiyarbepsy (talk) 04:16, 24 October 2014 (UTC)

It is unsafe to classify all migraines to be neurovascular. They're kind of a drawn-out symptom in a lot of cases, and the cause is sort of determined by what sort of medications you respond to. In my experience, however, migraine tends to be co-morbid with other health issues. For example, my migraines seem to be purely neurological, since blood pressure medicine and other treatment besides Rizatriptan. I've got numerous other neurological problems – including Cyclic vomiting syndrome, which also produces migraines – so this isn't hard to believe. Some other migraine patients I know seem to respond better to the neurovascular treatment, but they also have other cardiovascular problems such as arrhythmia. It might be best to edit the sentence to, "Most migraines are believed to be neurovascular in origin." — Preceding unsigned comment added by Crossark (talk • contribs) 00:04, 15 January 2015 (UTC)

On Auras

Migraine Auras are a lot more complicated than the given section would entail. It would be wise of us to include a small note that while visual, auditory, and motor symptoms are most common, they are not the only sort of auras a person can experience; pretty much every hallucination or delusion archetype you can think of can be experienced because of the nature of a migraine. I believe Oliver Sacks has some information about this in his book "Hallucinations".

Sincerely, A Wikipedian whose aura consists only of a strong feeling of foreboding.

Crossark (talk) 23:40, 14 January 2015 (UTC)

New prophylaxis and treatment

doi:10.1016/S1474-4422(15)00198-2 Lancet Neurol JFW | T@lk 14:58, 24 September 2015 (UTC)

Where is the RESEARCH category?

There is no mention of new Dutch research on new cause being the nerve receptors.

Review on the topic? Doc James (talk · contribs · email) 21:19, 14 October 2016 (UTC)

Flashing image

In this thread on Dreamwidth, someone says the scintillating scotoma image—which is an obvious potential trigger for migraineurs or epileptics—is unhidden by default in mobile view. Since more and more of our readers are accessing Wikipedia via mobile devices, if true, this is highly undesirable. Can anything be done display-wise? If not, I suggest we replace the animated image immediately with a static shot linking to the animated version, the way we treat embedded film clips. Yngvadottir (talk) 18:36, 21 December 2016 (UTC)

 Done Mikael Häggström (talk) 17:35, 3 January 2017 (UTC)

Thanks User:Mikael Häggström much prefer that format. Doc James (talk · contribs · email) 09:35, 4 January 2017 (UTC)

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NEJM

doi:10.1056/NEJMcp1605502 JFW | T@lk 16:39, 14 August 2017 (UTC)

Minor word usage

The article uses the phrase "a sense of the world spinning" with a link to the article on vertigo. Wouldn't it be more succint/scientific to use use the word vertigo? I have not read the subsequent citation so if it uses the phrase "a sense of the world spinning," we should keep it. Otherwise, it should change. Ehgarrick (talk) 23:15, 13 October 2017 (UTC)

Vertigo has more than one meaning and is often understood. So it is best to define it. Doc James (talk · contribs · email) 04:26, 14 October 2017 (UTC)

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