Talk:Migraine

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What about "complex migraines", also known as "variant migraines"?

I was confused to find nothing on the page about migraines whose symptoms are out of order or include unusual extra symptoms like hemiparesis/weakness, loss of vision, or difficulty speaking. The confusion between how such a complex migraine presents itself with the symptoms of a stroke can be terrifying to someone experiencing them. Might be worth a citation or two. Starters:

• http://newsblog.mayoclinic.org/2011/02/22/complex-migraine/
• http://www.ncbi.nlm.nih.gov/pubmed/21049701
• http://www.news-medical.net/news/20120516/Dangerous-complex-migraines-linked-to-high-risk-for-stroke.aspx
• http://www.webmd.com/migraines-headaches/hemiplegic-migraine-headaches-symptoms-causes-treatments — Preceding unsigned comment added by 97.122.184.242 (talk) 05:00, 19 June 2013 (UTC)

Before commenting, please review the archives

Before commenting, please review the archives as numerous topics have been previously discussed. If necessary, reference the appropriate archived discussion.

So; how do we review the archives / reference an archived discussion? Ocdnctx (talk) 13:15, 12 November 2011 (UTC)

Classification ?arbitrary

I added the POV tag to the statement calling the ICHD classification arbitrary and unsupported; the only reference given for this is the ICHD itself, which sounds tendentious. Do we have a separate reference for the lack of scientific suppport for the classification? If not, we ought to remove the sentence. 07:07, 8 April 2012 (UTC) — Preceding unsigned comment added by Docben (talk • contribs) 12:58, 20 January 2012 (UTC)

Classification; ?NPOV

I added the POV tag to the statement calling the ICHD classification arbitrary and unsupported; the only reference given for this is the ICHD itself, which sounds tendentious. Do we have a separate reference for the lack of scientific suppport for the classification? If not, we ought to remove the sentence. 07:07, 8 April 2012 (UTC) — Preceding unsigned comment added by Docben (talk • contribs) 15:53, 20 January 2012 (UTC)

Prevention

I have just segregated the individual therapies discussed in 'prevention'. I have also cut-out alot of detail from the 'prevention' section of this article and have moved it all to the main "migraine prevention' article. The prevention section here is now much shorter. Comments? Puhlaa (talk) 16:19, 8 April 2012 (UTC)

Have combined some together. We try to avoid one sentence paragraphs. Everything in this article should be support by reviews. --Doc James (talk · contribs · email) 18:13, 8 April 2012 (UTC)

A couple new reviews

• http://www.neurology.org/content/78/17/1337.full
• http://www.neurology.org/content/78/17/1346.full
• http://www.cma.ca/index.php?ci_id=204438&la_id=1

Doc James (talk · contribs · email) 11:40, 24 April 2012 (UTC)

Percentage of auras.

I have just read a little bit of this article, and one spot says 1/3 of people experience auras (33%), another says a "small" percentage, and another 15%. This needs to be sorted out. If there is debate, it should be clarified, and not having disparate numbers across the article. It makes me not trust the article seeing unexplained ambiguity like this.

Peace and Passion ☮  ("I'm listening....") 17:39, 9 May 2012 (UTC)

I have not gotten to a comprehensive update yet. But will take care of this now. I would not completely trust this article as it stand now either. --Doc James (talk · contribs · email) 19:08, 9 May 2012 (UTC)

Triggers Section Needs Work

The Triggers section needs some attention from someone with access to WP:MEDRS-quality journal articles. It's out-of-date and also missing a lot of relevant information. In surveying the various migraine/headache websites, there is not a lot of evidence-based info on migraine triggers available to the general public, so this would be a valuable and unique contribution. I will try and get temporary access to journals beyond free-text, but if there is someone else who would like to help out that would be great. --Nicely0Done (talk) 16:45, 17 June 2012 (UTC)

Have removed the primary research which was added Doc James (talk · contribs · email) 05:02, 20 June 2012 (UTC)

neurological vs. vascular

I read the archive and considering the energy expended discussing the use of disease vs. disorder, I wanted to discuss this before making an edit.

In the first paragraph we have this statement: "Although some believe it to be a neurological disorder, there is no evidence to confirm this theory.[1]"

While the second paragraph has this statement: " ... symptoms are generally aggravated by routine activity.[5][6]"

Please Note: [6] states " ... Researchers believe that migraine is the result of fundamental neurological abnormalities caused by genetic mutations at work in the brain."

Other places in the article state:

" ... An aura comprises focal neurological phenomena that precede or accompany the attack. "

" ... It has been estimated to be the most costly neurological disorder in the European Community, costing more than €27 billion per year."

So my suggestion is to remove black and white statements such as the one stating "Although some believe it to be a neurological disorder, there is no evidence to confirm this theory.[1]" Siting a single source (which by the way, you have to pay for to read) which may be of the opinion that there is no evidence of a neurological disorder, does not mean that there is, in fact, no evidence. I believe that the other researchers that tend toward a neurological basis would beg to differ.

As a matter of fact, in the abstract for the referenced article, it says " ... A debate is presented that examines whether it is the blood vessel or the brain that determines the essence of migraine." Seems like that debate was boiled down to a one-sided conclusion.

I think we should stick to what is known, and be clearly referenced, on both sides of the argument, without coming to our own conclusions. So I suggest either removing the statement from the opening of the article, or at least move it down to the Pathophysiology section, where it can be discussed. Bobsd (talk) 22:17, 18 June 2012 (UTC)

I could not find in the ref provided the statement that their is no evidence it is a neurological disorder. I did however find a 2010 review which states it is a neurovasuclar disorder.Doc James (talk · contribs · email) (please reply on my talk page) 03:25, 25 June 2012 (UTC)

WP:MEDRS

This page needs to follow WP:MEDRS. Some reviews below...

• Bartleson JD, Cutrer FM (2010). "Migraine update. Diagnosis and treatment". Minn Med. 93 (5): 36–41. PMID 20572569. {{cite journal}}: Unknown parameter |month= ignored (help)
• Bigal ME, Lipton RB (2008). "The prognosis of migraine". Curr. Opin. Neurol. 21 (3): 301–8. doi:10.1097/WCO.0b013e328300c6f5. PMID 18451714. {{cite journal}}: Unknown parameter |month= ignored (help)
• Pringsheim T, Davenport WJ, Becker WJ (2010). "Prophylaxis of migraine headache". CMAJ. 182 (7): E269–76. doi:10.1503/cmaj.081657. PMID 20159899. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Robertson CE, Black DF, Swanson JW (2010). "Management of migraine headache in the emergency department". Semin Neurol. 30 (2): 201–11. doi:10.1055/s-0030-1249228. PMID 20352590. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Mueller LL (2007). "Diagnosing and managing migraine headache". J Am Osteopath Assoc. 107 (10 Suppl 6): ES10–6. PMID 17986672. {{cite journal}}: Unknown parameter |month= ignored (help)
• Cutrer FM, Huerter K (2007). "Migraine aura". Neurologist. 13 (3): 118–25. doi:10.1097/01.nrl.0000252943.82792.38. PMID 17495755. {{cite journal}}: Unknown parameter |month= ignored (help)
• Ebell MH (2006). "Diagnosis of migraine headache". Am Fam Physician. 74 (12): 2087–8. PMID 17186716. {{cite journal}}: Unknown parameter |month= ignored (help)

Doc James (talk ·contribs ·email) 23:23, 3 December 2010 (UTC)

• Gilmore, B (2011 Feb 1). "Treatment of acute migraine headache". American family physician. 83 (3): 271–80. PMID 21302868. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Doc James (talk · contribs · email) (please reply on my talk page) 11:36, 7 July 2012 (UTC)

MSG

The 1991 source about MSG being a trigger is too old to be used, per MEDRS. Please use sources that qualify for MEDRS before re-adding. Yobol (talk) 16:36, 8 July 2012 (UTC)

Agree. Doc James (talk · contribs · email) (please reply on my talk page) 00:10, 9 July 2012 (UTC)

Moved from main area

• The 2012 AHS/AAN Guidelines for Prevention of Episodic Migraine

Doc James (talk · contribs · email) (please reply on my talk page) 18:00, 11 July 2012 (UTC)

GA Review

This review is transcluded from Talk:Migraine/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: MathewTownsend (talk · contribs) 19:58, 28 August 2012 (UTC)

• I'll review this! Reading it answered one of my long-standing questions. MathewTownsend (talk) 19:58, 28 August 2012 (UTC)

review

• more than 10%; 90 percent - should  % or percent consistently - the article is inconsistent in this respect.

Done Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:00, 30 August 2012 (UTC)

• Overall the article is very interesting but a little hard to follow. I assume that the sections are following a formula for medical articles. I have some comments that may or may not be relevant.

Follows WP:MEDMOS yes Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:01, 30 August 2012 (UTC)

• neurovascular disorder - what is this (perhaps the explanation is too technical for this article)

a disorder that involves nerves and blood vessels Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:53, 30 August 2012 (UTC)

• why is Abdominal migraine discussed under "Signs and symptoms"?

This is another presumed presentation of migraine headaches along with cyclical vomiting syndrome. I guess we could move it to the section on diagnosis as it really is uncommon. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:51, 30 August 2012 (UTC)

• Basilar migraine redirects to migraine so what is a basilar migraine?

Added further details Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:55, 17 September 2012 (UTC)

• "They do run in families in about two-thirds of cases" - doesn't seem like encyclopedic language

Fixed Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:55, 17 September 2012 (UTC)

• "Migraines may be induced by triggers, with some reporting it as an influence in a minority of cases[5] and others the majority." - some people or some research review articles?

Both. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:04, 30 August 2012 (UTC)

• "spreading depression of Leão" - what is Leão?

Someones name Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:48, 30 August 2012 (UTC)

• "Trepanation, the deliberate drilling of holes into a skull, was practiced as early as 7,000 BCE." - what is the relevance, as it's only mentioned at the end of the paragraph that William Harvey recommended it as a treatment in the 17th century. - the image, though nice, seems irrelevant and off topic -

This is a discussion of the early treatments of migraine headaches. We could go into more depth. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:50, 30 August 2012 (UTC)

• Why is the "Research" section so sparse? Is that all that's being researched? Shouldn't possible treatments be under "Management"/Treatment?

I never put possible treatments under treatment. These are typically not available. Yes more research is being done but it is only a GA and research is not really my area of interest. I am more interested in what is done now :-) Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:45, 30 August 2012 (UTC)

• Under diagnosis, it says that if a person has two attacks (or more) with aura, it is diagnosed as migraine. Then it says "If someone experiences two of the following: photophobia, nausea, or inability to work / study for a day the diagnosis is more likely.[57] In those with four out of five of the following: pulsating headache, duration of 4–72 hours, pain on one side of the head, nausea, or symptoms that interfere with the person's life, the probability that this is a migraine is 92%.[11] In those with less than three of these symptoms the probability is 17%." - what is the "ultimate" test of what a migraine is? (or whether a person is correctly diagnosed?)

The IHS criteria are the ultimate method of diagnosis. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:55, 17 September 2012 (UTC)

MathewTownsend (talk) 21:37, 29 August 2012 (UTC)

GA review-see WP:WIAGA for criteria (and here for what they are not)

1. Is it reasonably well written?

   a. prose: clear and concise, respects copyright laws, correct spelling and grammar:

   b. complies with MoS for lead, layout, words to watch, fiction, and list incorporation:

2. Is it factually accurate and verifiable?

   a. provides references to all sources in the section(s) dedicated to footnotes/citations according to the guide to layout:

   b. provides in-line citations from reliable sources where necessary:

   c. no original research:

3. Is it broad in its coverage?

   a. it addresses the main aspects of the topic:

   b. it remains focused and does not go into unnecessary detail (see summary style):

4. Does it follow the neutral point of view policy.

   fair representation without bias:

5. Is it stable?

   no edit wars, etc:

6. Does it contain images to illustrate the topic?

   a. images are copyright tagged, and non-free images have fair use rationales:

   b. images are provided where possible and appropriate, with suitable captions:

7. Overall:

   Pass or Fail:

• Congratulations on a very informative article. (I've made a few edits that you're free to change.[1]) MathewTownsend (talk) 18:40, 2 September 2012 (UTC)

Many thanks. I will try to address any remaining when I get home. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:12, 2 September 2012 (UTC)

Illustrations of visual migraine aura

Example of a scintillating scotoma aura with each dot or line flickering.

The reference Exploring the visual hallucinations of migraine aura by Schott accurately depicts the phosphene (expanding fortification spectrum) and featureless (not black) trailing scotoma. But the illustrations showing a brown and yellow Roman building with a dark area or fortification spectrum with no scotoma are inaccurate. The illustration of the phosphene against an ocean background is more accurate than the Roman building illustration. The phosphene appears as a bright (not dark) flickering patch that totally replaces the details of an expanding area of the background image. Greensburger (talk) 06:37, 22 October 2012 (UTC)

That image is blurry. We need a better one. It does not look like the ones in the ref you link [2] We could use the images in this document as they are from 1902. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:55, 22 October 2012 (UTC)

Migrainous delirium and hallucinations

A while back, I had included information on this phenomenon. It was properly cited (using books by Oliver Sacks as source material). It was relevant and valid information, and need not have been removed. That is all. — Preceding unsigned comment added by 67.83.213.205 (talk) 07:25, 20 November 2012 (UTC)

Sure issues are 1) no page numbers where given. While these phenomenon may occur, that they occur commonly is not supported 2) we do not typically use the popular press for medical content per WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:43, 23 November 2012 (UTC)

An aura by the way is a type of hallucination and we already discuss this in depth and state just how common it is. If it does state that delirium is common please state what page in what ref this is on as I may have missed it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:48, 24 November 2012 (UTC)

Agree that the article already has hallucination (aura) covered with appropriate balance. DSM-IV's long list of causes of delirium does not include migraine. -- Scray (talk) 16:28, 24 November 2012 (UTC)

This reference states "Acute confusional migraine occurs almost exclusively in children and adolescents and is characterized by confused behavior occurring as a prodrome to the migraine headache." However it doesn't say if this symptom is "common". Axl ¤ [Talk] 11:17, 24 November 2012 (UTC)

Agree. Moreover, it is important to avoid any implication that persons with migraine have a high incidence of thought disorder, because systematic review has shown that is not the case in children, for example (PMID 20603260). -- Scray (talk) 16:28, 24 November 2012 (UTC)

The Oliver Sacks book Migraine should not be used as a source for medical information for this article. That book is a 1999 popular-press book; we're looking for recent (last 2-3 years ideally) peer-reviewed review articles and systematic reviews, or statement by national medical organizations, or similar. Please see WP:MEDRS. Zad68 03:44, 25 November 2012 (UTC)

Hello. Regarding the Oliver Sacks books being legitimate sources, my brother (the guy insisting that the Sacks books are legit) is highly biased. I suffer from chronic, severe migraine, and the worst ones are accompanied by hallucinations that go far beyond the mere visual misperceptions associated with aura. In both my brother's and my own opinion, the Sacks books feel like a validation of my experience. So my brother feels like he's protecting me and that Doc James is a bully. Once the situation has been framed in his mind in such a way, he will never back down.

Problem is, my brother is a confessed Internet addict who, by his own admission and our personal agreement with each other, has no business editing Wikipedia. Is there any way to ban or block him from doing so by using IP address alone? I don't use Wikipedia myself (except to read it) so if there's another page, place, or way to make this request, I'm gonna be lost. — Preceding unsigned comment added by 67.83.213.205 (talk) 11:19, 25 November 2012 (UTC)

Hi, I agree with everything my brother just said above, and agree that blocking me from Wikipedia might be for my own good. The only thing I disagree about is that Doc James is just a bully and a jerk.

environmental influence

The sources for this section must be out of date. Weather is such a well known trigger for migraine that the Accuweather website has a special tab for it. It is extremely accurate in my case; years ago I identified the Alberta Clipper weather front as one of my triggers. 71.163.114.49 (talk) 13:23, 24 January 2013 (UTC)

It is very uptodate. There is poor evidence to support the correlation you mention. This from Sept 2012 http://www.neurology.org/content/early/2013/01/23/WNL.0b013e31827f0f10.abstract which of course is a primary source and not suitable here but interesting none the less. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:35, 24 January 2013 (UTC)

Lightning

Please stop deleting the Meeja.com.au entry on lightning as a trigger. Wiki guidelines state that ideal sources for such content includes general or systematic reviews published in reputable medical journals. You cannot link to the review article on this research by the University of Cincinnati without a subscription. Therefore, the outlet in question has used a Eurekalert report as a basis for the article, which is universally accepted as a reliable source. Just Undoing references does not help. If you must, find another source to replace it - there have been hundreds published today using the same Eurekalert report as a basis for information.

The popular press is not a reliable source for medical content. Link to the ref is here [3] Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:29, 25 January 2013 (UTC)

It is a popular press cite of a primary study - exactly the kind of thing WP:MEDRS tells us not to use. See the section above this one. If you want to avoid a block you should self revert right now. Zad68 00:34, 25 January 2013 (UTC)

I just reverted this content because the source provided is a website and does not meet WP:MEDRS. The website says: "University of Cincinnati researchers are reporting the results of the first study to find that lightning may affect the onset of headache and migraines.", thus the website is discussing a primary study, which is also not ordinarily suitable for inclusion in medical articles. Puhlaa (talk) 01:07, 25 January 2013 (UTC)

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" [4] 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." [5] 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."[6] 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" [7] 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)