Why don't doctors prescribe natural remedies for medical disorders such as migraine headaches? After all, safety is the first concern of people when they are prescribed a medication. Safety should also be the first concern of their doctors, yet often it is not. Doctors may protest that safety is their first concern, but their actions say otherwise. Propranolol is a frequently prescribed medication for preventing migraines. Yet propranolol can cause your gums to recede enough to alarm your dentist. It can reduce your ability to exercise by half. A brief list of the hundreds of adverse effects that can occur with propranolol include vertigo, fatigue, headache, mental depression, peripheral nerve abnormality, anxiety, impaired concentration, nightmares, gastritis, hair loss, nausea, sweating, sexual dysfunction, liver irritation, joint pain, muscle cramps, burning eyes, facial swelling, and cardiac arrhythmia.1 In contrast, riboflavin is a natural substance made in small amounts by your own body. Therefore, supplemental riboflavin is a bioidentical remedy, which means your body does not react to it as a foreign substance. As such, its side effects are rare. Riboflavin and propranolol are equally effective in preventing migraines. If given a choice, which treatment would you try first to prevent your migraines? The riboflavin, of course. Yet, which would your doctor choose first? Likely, the propranolol. MORE THAN AN INFORMATION GAP You might think that doctors stick with the medication-first approach because they do not possess enough information about natural remedies. Yet, how can this be, when medical journals first reported the benefits of magnesium in 1933, of niacin in 1944, and of riboflavin in 1946? In fact, there is plenty of evidence, including multiple studies in medical journals, of the effectiveness of many natural therapies. For half a century, ample proof has been available regarding the benefits of magnesium or niacin given intravenously for acute migraines, yet emergency doctors persist in using injectable drugs that have dangerous, sometimes lethal, side effects. NATURAL REMEDIES FOR MIGRAINES AND THE YEARS MEDICAL JOURNALS FIRST REPORTED THEIR BENEFITS Magnesium: 1933 Niacin: 1944 Riboflavin: 1946 Biofeedback: 1972 5-HTTP: 1973 Feverfew: 1985 Ginger: 1990 Acupuncture: 1992 Vitamin D: 1994 Gamma linolenic acid: 1997 Butterbur: 2000 Coenzyme Q10: 2002 Melatonin: 2004 White willow: 2006 Alpha lipoic acid: 2007 Ginkgo biloba: 2009 A basic principle of optimal medical care is to use the safest remedies first for people with health problems. So why don't doctors embrace these effective natural treatments for their migraine patients? Why not try these safer approaches first and then go to a prescription drug if necessary? WHAT IS RELIABLE EVIDENCE? Most doctors are good people who want to help their patients. The problem is not doctors' intentions, but the sources of information and other influences from which doctors make treatment decisions. In recent years, mainstream medicine has adopted a new standard of medical care known as evidence-based medicine. This standard makes sense and is long overdue, as studies of doctors' methods have shown that their decision-making is often unscientific. Physicians are now encouraged to make treatment choices based on reliable, evidence-based information. Yet, what information do doctors accept as evidence-based? If you were to ask them what "evidence-based medicine" means, many would say it means using only the findings of big drug company-run studies. Unfortunately, throughout their training, future physicians are taught that big studies are the sole source of information worth considering. This viewpoint is flawed. While these large reports can produce good data, they often have many flaws and can mislead the medical profession and the public. The following list details the ways in which major drug company studies may be unreliable. • Biased Comparisons. Drug companies compare their new drugs to older, less effective drugs. This makes their products appear better than they actually are. • Favorably Designed Studies. Drug companies can design their studies to obtain better outcomes. They can also avoid doing important research that might reveal unfavorable results or serious risks of a drug. Studies conducted by the manufacturer of a drug being researched frequently yield more favorable results than do independent studies. • Manipulating Measurements of Effectiveness. Drug companies can employ several measures of effectiveness, and then pick and choose the most favorable ones while suppressing those that are unfavorable. The new drug is then promoted with a misleadingly positive profile. • Non-Representative Subjects. Drug studies are sometimes conducted with young, healthy subjects rather than older subjects, even if the new drug will be used primarily by older patients. Young subjects usually report better rates of improvement and fewer side effects. This provides impressive yet inaccurate data about the benefits of the drug. • Publication of Only Favorable Studies. Drug companies can pick and choose among multiple studies, publishing only the most favorable ones. • Stacking Data. A limited amount of favorable data about a drug can be amplified by repackaging the information into different articles by different authors in different journals, creating the impression that the favorable data are considerable when, in fact, the results are limited. • Suppression of Vital Information. If a study's results aren't to a drug company's liking, that company can suppress the data or impede publication of the report. It can also keep a study from public awareness by declaring it "proprietary information." Some researchers determined to publish important side-effect warnings have even been threatened with lawsuits or the loss of their jobs. Doctors are generally unaware of these problems. Prospective physicians are trained to copy the methods of their teachers. They are not educated to ask questions or seek better ideas. Furthermore, medical schools have become increasingly reliant on research funding from drug companies, and medical school teachers, many of whom are recipients of drug company handouts, often share their drug-first view of medical therapy with their students. In light of these facts, it has been easy to convince doctors that only studies sponsored by drug companies are worth believing. The irony, however, is that pharmaceutical companies are forced by the US Food and Drug Administration (FDA) to conduct large studies that involve thousands of patients because their drugs run a high risk of being toxic. In contrast, natural therapies do not require large studies because of their high degree of safety. Yet, the pharmaceutical industry has been able to turn this reality on its head, convincing doctors that reports of natural remedies are not large enough to be credible. The result of unrelenting propaganda of this nature is that many doctors have closed their minds to important information about natural remedies. A woman recently told me, "When I told my doctor that magnesium had greatly reduced my migraines, my doctor said, 'That's nice,' and then changed the subject. I had hoped he would be interested enough to tell his other migraine patients, but he wasn't interested." I have heard stories like this from dozens of patients. Doctors have been trained to be skeptical about any individual reports because they do not consider them reliable, or, in other words, evidence-based. Indeed, physicians have learned to dismiss individual reports and sneer at any data termed "anecdotal." This narrow-mindedness often includes cases mentioned in medical journals, even though these articles have been peer reviewed, which means they have been read and approved by other doctors before being accepted for publication. Consider this: Most people with long histories of migraines have usually tried every substance under the sun, including prescription pharmaceuticals, over-the-counter drugs, and dietary supplements, seeking relief. If nothing has worked, it is obvious that these people are not susceptible to the placebo effect that can occur as a result of trying a new potential remedy. When such a person tries a new therapy and it works, I consider this response to be highly significant, provided the benefits last at least six months. And you can bet I mention this treatment to other migraine sufferers. It is odd that doctors have been trained to disdain individual reports. A person's own experience can be as valuable, or even more valuable, than the results of elaborate studies. So, the next time your doctor dismisses your experience with a natural remedy, remind him that the FDA places a high value on the anecdotal case stories it receives. When it comes to the public's safety, the FDA will ban a drug if it receives enough reports of serious harm or death from the substance, no matter if the drug manufacturer has conducted fifty major studies attesting to the safety of the pharmaceutical. If the FDA puts such weight on individual experiences, why don't doctors? EVIDENCE-BASED MEDICINE: WHAT IT IS AND WHAT IT IS NOT Believing solely in evidence provided by large corporate-sponsored studies can be counterproductive and harmful to patients. If doctors trust only drug company-generated reports, their treatment decisions will be drugs first, second, and third. I am not against medications, which help millions of people, but I am against a medication-first mentality when there are other, safer, evidence-based options. Maybe doctors should be reminded what the term evidence-based medicine actually means. Here is an appropriate definition written by experts in a book titled Evidence-Based Medicine: What It Is and What It Isn't : The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. . . . Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. . . . Evidence-based medicine is not restricted to randomized trials and meta-analyses.2 What this means, in effect, is that clinical experience, which refers to experience treating individuals, is as important as big studies. And this definition does not stand alone. Many other experts have echoed the idea that big drug-company studies are not the only valid source of information. Individual experiences count. Small studies count. Open label studies, in which doctors and patients know what the treatment is, count. Retrospective analyses count. Epidemiological studies count. Each of these sources is important. Your experiences count! Recently, a patient of mine, a very bright doctor of psychology, showed her medical doctor a study involving a natural remedy for pain. The results of the study were excellent, but her physician rejected the results because the study was "too small." The study involved 450 subjects. It was not a small study for a natural remedy. But this doctor's mind was made up, having bought in long ago to the drug-company line that says only huge studies count. That's what he was taught, and that's what he wanted to believe. In doing so, he had closed the door on anything other than prescription pharmaceuticals--despite scientifically valid evidence to the contrary. When physicians dismiss studies because they are "too small," or personal experiences because they are "anecdotal," they violate the basic tenets of evidence-based medicine. The best evidence is found when all of these sources are properly considered, which this book attempts to do. What Evidence-Based Medicine Really Means "Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values." --- Evidence-Based Medicine: How to Practice and Teach EBM 3 "Evidence-based medicine has been defined as 'the integration of the best research evidence with clinical expertise and patient values.' Unfortunately, it is considered by many [doctors] to be synonymous with reviews and guidelines produced in 'ivory towers' with questionable local applicability and relevance to the personal circumstances of many patients." --- Emergency Medicine Australasia 4 "The practice of medicine is in effect the conducting of clinical research. . . . Every practicing physician conducts clinical trials daily as he is seeing patients. From this perspective, both clinical trials and medical care are conceived as scientifically guided, therapeutically oriented activities conducted within the context of the physician-patient relationship." --- New England Journal of Medicine 5 EVIDENCE-BASED PROOF FOR NATURAL REMEDIES Each of the therapies discussed in this book is supported by legitimate studies. Most of these studies are prospective, which are the best kind of studies, as they measure what actually happens when specific remedies are given to subjects. Many of these studies are double-blind and placebo-controlled. Others are open trials, in which doctors, and sometimes patients, know which remedies are being given, and results are compared with migraine frequency before treatment. This book also contains individual case reports and series of cases. All of the studies and most of the case reports were published in medical journals after rigorous peer review. Each of these forms of information fits within the definition of evidence-based information. As you will see, some of these natural remedies are equally effective or superior to many of the prescription drugs doctors commonly prescribe for migraines, andmainstream medical science is only beginning to accept this fact. In a review article published in 2005 that listed all of the proven effective methods of migraine prevention, five natural remedies (magnesium, riboflavin, coenzyme Q10, butterbur, and feverfew)were mentioned alongside thirty-five pharmaceuticals. In 2009, the Cochrane Collaboration-- one of the most respected institutions in the world regarding medication therapy-- published a huge review that compared studies of acupuncture for migraines. After examining twenty-two studies involving 4,419 subjects, the report concluded that "available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects."7 Another large review of studies on migraine prevention found riboflavin and the herb feverfew to be as effective as the drugs gabapentin (Neurontin), verapamil (Calan), aspirin, naproxen (Aleve), and atenolol (Tenormin), which is similar to propranolol. Moreover, these natural remedies ranked superior for preventing migraines than amitriptyline (Elavil), diltiazem (Cardizem), ibuprofen (Motrin), and cyproheptadine (Periactin). The author of the review, Dr. C. Landy, stated: Nonpharmacologic treatments may be appropriate for patients who prefer such treatment, or for those who do not benefit from or are unable to take specific pharmacologic treatments because of poor tolerability, medical contraindications, pregnancy or nursing.8 This is a perfectly reasonable recommendation. The fact is that there is plenty of evidence-based proof supporting the use of natural remedies to stop migraines. If you are reading this book, you are already open to this idea. Perhaps someday the majority of doctors will be as well, which would allow them to discover the benefits of these natural therapies for themselves. As suggested in an article by R.W. Evans and F.R. Taylor: Many migraineurs are quite concerned about the toxicity of prescription medications and prefer alternative treatments regarded by them to be "natural" and thus relatively free of any side effects. If you (doctors) are knowledgeable about these treatments, patients are likely to perceive you to be an enlightened physician who understands and is sympathetic to their concerns and preferences.9 We all win when migraineurs are helped by natural remedies. Individual sufferers are relieved of the pain and limitations brought about by their migraines. Doctors obtain the satisfaction of helping many while harming few. Health care costs drop dramatically, with fewer doctor and emergency room visits, and fewer pricey drugs. At your next doctor's appointment, ask your physician if there are any natural treatments for migraines that might work for your condition. If you have read some impressive studies on natural treatments for migraine headaches, ask your doctor to look at the information with you. While you do not need your doctor's approval to try any of the remedies in this book, talking about the subject of natural therapies may broaden your physician's outlook, which may lead to more open-minded therapy options for other migraine patients. The mainstream medical attitude will change only from the ground up, because the drug industry and academic medicine tightly control medical school education and doctors' continuing education. So, gently, respectfully, offer what you've learned to your doctors. Tell them what has helped you. Some of your doctors may surprise you and show an interest. For the others, at least you have planted a seed that may grow if other patients do the same. In the meantime, you have done a good deed, and good deeds have a way of adding up. This is why I have written this book, and this is why you are reading it now. It is said that the pen is mightier than the sword. Indeed it is, but only when people like you and I carry ideas such as these forward. I hope the following remedies help relieve your migraines and those of your loved ones, and make the medical system a little better and a little safer at the same time. Excerpted from 15 Natural Remedies for Migraine Headaches: Using Natural Supplements, Nutrition and Alternative Therapies to Better Manage Migraine Pain by Jay S. Cohen All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.