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LETTER |
University of North Texas Health Science Center at Fort Worth—Texas College of Osteopathic Medicine Researcher, Biotics Research Corporation Rosenberg, Texas
To the Editor: As a researcher, chiropractic clinician, and beginning first-year osteopathic medical student, I found several short-comings in the review of pediatric migraine by Andrew D. Hershey, MD, PhD, and Paul K. Winner, DO, appearing in the supplement to the April 2005 issue of JAOA—The Journal of the American Osteopathic Association (2005;105[4 suppl 2]:S2–S8). Specifically, the authors neglected to accurately detail nonpharmacologic treatment modalities such as dietary and nutritional interventions. Further, they do not mention manipulative treatment.
In contrast to the description of the osteopathic medical profession by the American Osteopathic Association,1 namely, "doctors of osteopathic medicine, or D.O.s, apply the philosophy of treating the whole person to the prevention, diagnosis and treatment of illness, disease and injury," Drs Hershey and Winner essentially reviewed only pharmacologic treatment. They dedicated 2597 words (97.7%) to pharmaceutical treatment but incompletely reviewed nonpharmacologic treatment modalities in only 62 words (2.3%).
Drs Hershey and Winner did not mention clinical trials showing benefit of magnesium supplementation in pediatric patients with migraine.2 Modes of therapy under the genre of "biofeedback" appear to be safe and effective for pediatric migraine.3-5 Perhaps more important, the authors neglected to objectively review data on diets that eliminate food allergens, which have been proved effective as a migraine preventive in children6,7 and adults.8 Furthermore, while it is true that the adult studies documenting the antimigraine benefits of spinal manipulation,9 coenzyme Q10 (CoQ10),10 riboflavin,11 feverfew,12 Petasites hybridus,13 vitamin D,14 cobalamin,15 5-hydroxytryptophan,16 and combination fatty acid therapy17 need to be replicated in children, Drs Hershey and Winner either ignored or too quickly dismissed these low-cost, low-risk interventions, which have shown clinical efficacy when used singly and which may also be used safely in combination.18,19
Although the US Food and Drug Administration generally does not "approve" the use of nutritional supplements for the treatment of disease in the same way that it does pharmaceutical medications, lack of such approval does not imply lack of efficacy or safety. To my immediate knowledge, only soy, dietary fiber/fruit/vegetables, stanols/sterols, calcium, and folic acid have received such "approval" for health claims (see http://www.cfsan.fda.gov/%7Edms/flg-6c.html). Nonetheless, as noted in the previous paragraph, there exist studies proving the effectiveness of riboflavin, CoQ10, magnesium, biofeedback, elimination of food allergens, spinal manipulation, feverfew, Petasites hybridus, 5-hydroxytryptophan, and fatty acids against migraine. Furthermore, for example, studies have shown that omega-3 fatty acids reduce the risk of cardiovascular death more effectively than statin drugs, which are "approved," yet I am not aware that fatty acids have been officially "approved" despite this obvious show of safety and effectiveness.20
It is hoped that future reviews in this journal can include a more balanced survey of the literature, inclusive of non-pharmacologic and "holistic" interventions that are consistent with osteopathic philosophy.
Dr Vasquez disclosed that he has been a researcher for Biotics Research Corporation in Rosenberg, Tex. Biotics Research Corporation does not sell products, testing, treatments, or training associated with biofeedback, food allergy, spinal manipulation, feverfew, Petasites hybridus, or high-dose riboflavin. Biotics Research Corporation does produce nutritional supplements containing magnesium, coenzyme Q10, vitamin D, cobalamin, 5-hydroxytryptophan, and fatty acids.
References 2. Wang F, Van Den Eeden SK, Ackerson LM, Salk SE, Reince RH, Elin RJ.
Oral magnesium oxide prophylaxis of frequent migrainous headache in children:
a randomized, double-blind, placebo-controlled trial.
Headache. 2003;43:601
–610.[Medline] 3. Scharff L, Marcus DA, Masek BJ. A controlled study of
minimal-contact thermal biofeedback treatment in children with migraine.
J Pediatr Psychol.2002; 27:109
–119. 4. Siniatchkin M, Hierundar A, Kropp P, Kuhnert R, Gerber WD, Stephani
U. Self-regulation of slow cortical potentials in children with migraine: an
exploratory study. Appl Psychophysiol Biofeedback.2000; 25:13
–32.[Medline] 5. Sartory G, Muller B, Metsch J, Pothmann R. A comparison of
psychological and pharmacological treatment of pediatric migraine.
Behav Res Ther.1998; 36:1155
–1170.[Medline] 6. Egger J, Carter CM, Wilson J, Turner MW, Soothill JF. Is migraine
food allergy? A double-blind controlled trial of oligoantigenic diet
treatment. Lancet.1983; 2:865
–869.[Medline] 7. Egger J, Carter CM, Soothill JF, Wilson J. Oligoantigenic diet
treatment of children with epilepsy and migraine. J
Pediatr. 1989;114:51
–58.[Medline] 8. Grant EC. Food allergies and migraine.
Lancet. 1979;1:966
–969.[Medline] 9. Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of
chiropractic spinal manipulative therapy for migraine. J
Manipulative Physiol Ther.2000; 23:91
–95.[Medline] 10. Sandor PS, Di Clemente L, Coppola G, Saenger U, Fumal A, Magis D,
et al. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized
controlled trial. Neurology.2005; 64:713
–715. 11. Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose
riboflavin in migraine prophylaxis. A randomized controlled trial.
Neurology.1998; 50:466
–470.[Abstract] 12. Murphy JJ, Heptinstall S, Mitchell JR. Randomised double-blind
placebo-controlled trial of feverfew in migraine prevention.
Lancet. 1988;2:189
–192.[Medline] 13. Grossman W, Schmidramsl H. An extract of Petasites
hybridus is effective in the prophylaxis of migraine. Altern
Med Rev. 2001;6:303
–310.[Medline] 14. Thys-Jacobs S. Alleviation of migraines with therapeutic vitamin D
and calcium. Headache.1994; 34:590
–592.[Medline] 15. van der Kuy PH, Merkus FW, Lohman JJ, ter Berg JW, Hooymans PM.
Hydroxocobalamin, a nitric oxide scavenger, in the prophylaxis of migraine: an
open, pilot study. Cephalalgia.2002; 22:513
–519.[Medline] 16. Titus F, Davalos A, Alom J, Codina A. 5-Hydroxytryptophan versus
methysergide in the prophylaxis of migraine. Randomized clinical trial.
Eur Neurol.1986; 25:327
–329.[Medline] 17. Wagner W, Nootbaar-Wagner U. Prophylactic treatment of migraine
with gamma-linolenic and alphalinolenic acids.
Cephalalgia.1997; 17:127
–130.[Medline] 18. Maizels M, Blumenfeld A, Burchette R. A combination of riboflavin,
magnesium, and feverfew for migraine prophylaxis: a randomized trial.
Headache. 2004;44:885
–890.[Medline] 19. Vasquez A. Integrative Orthopedics: Concepts, Algorithms, and
Therapeutics. Houston, Tex: Natural Health Consulting Corp.
(www.OptimalHealthResearch.com.)
2004:49–130. 20. Studer M, Briel M, Leimenstoll B, Glass TR, Bucher HC. Effect of
different antilipidemic agents and diets on mortality: a systematic review.
Arch Intern Med.2005; 165:725
–730.
1. American Osteopathic Association. "About Osteopathic
Medicine." Available at:
http://www.osteopathic.org/index.cfm?PageID=ost_main.
Accessed August 11, 2005.
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