Headache Currents
HEADACHE CURRENTS
Editorial: Complementary and Alternative Medicine (CAM), Ayurvedic Medicine, and Research Into Behavioral and Mind/ Body Interventions in Headache Stewart J. Tepper, MD
This issue of Headache Currents offers three remarkable and remarkably different articles on nontraditional approaches to Headache Medicine. The articles vary as much as the treatments. Dr. Rob Cowan of Stanford addresses reality in Headache Medicine practice, that is, that patients are taking a potpourri of treatments, some that we prescribe, others that they find out about, and others that are recommended by Complementary and Alternative Medicine (CAM) practitioners. Dr. Cowan’s article is not a literature review. Rather he states, “Perhaps it is time to reconsider whether we are acting in our patients’ best interests by discounting (or worse, dismissing) treatments not objectively evaluated. Perhaps, in the absence of these objective evaluations, it is time we gave weight to traditions and clinical experiences that, in some cases, span thousands of years and millions of clinical experiences in the hands of countless non-Western practitioners.”1 He expands on this by considering a case of a patient in his practice who is on a wide group of treatments, some prescribed, some almost unheard of and unregulated. He tracks down some of them, like a detective, in descriptions of classical Chinese healing. Then he tries to give the reader his wisdom, guidance, and recommendations for the future. One of his endorsements is, when possible, to become familiar with some of the alternative systems used in treating headaches. In addition to classical Chinese, he mentions homeopathy and Ayurveda. He states, “Having a referral base that includes some of these practitioners is very helpful. Integrating these approaches into one’s own practice can be even more helpful, but requires considerable commitment in time and refocusing of the practice ... We don’t need to embrace every alternative medical system to serve our patients, but there exists a wide variety of modalities which, whether we incorporate them into our practices or not, need to be on our radar, and with which we need more than a passing familiarity. Moreover, we need to provide some guidance to our patients in these areas if we are truly to be their advocate in healthcare.” For this reason, I asked Dr. Trupti Gokani, who melds Western medicine and Ayurveda in her practice, to provide a description From the Cleveland Clinic, Cleveland, OH, USA. Address all correspondence to S.J. Tepper, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44106, USA. Accepted for publication March 2, 2014. ............. Headache © 2014 American Headache Society
of the Ayurvedic system for this issue, and how she uses Ayurveda in her headache treatments.2 This is an eye-opening review, and it immediately calls to mind Dr. Cowan’s admonition that “Because these are medical systems rather than discrete interventions, studies are much harder to come by and in general, each has its own internal logic. It is much more difficult to evaluate a system which is based on centuries of trial and error or an oral tradition.” I found Dr. Gokani’s summary riveting, and it will help me in talking with my patients who use this approach. The biggest problem in alternative care is squaring these treatments with the Western tradition and the requirement for rigorous evidence-based studies. In the third article in this month’s Headache Currents, Dr. Rebecca Wells and colleagues tease apart the requirements for adequate study in mind/body interventions in headache.3 This article is particularly useful in that the authors tightly organize the questions that remain in evidence-based mind/body interventions, the troubles in answering the questions, and how they might be addressed. The scope of their considerations, the hypotheses they suggest a need to evaluate, and the recommendations for the future are extremely clear and have the potential to be helpful as we proceed forward. Taken together, this is a startling trio of articles, and the accompanying references can help lead the interested reader to wider and varied possibilities in approaching our headache patients. References 1. Cowan R. CAM in the real world: You may practice evidence-based medicine, but your patients don’t. Headache. 2014;54:1097-1102. 2. Gokani T. Ayurveda – The science of healing. Headache. 2014;54: 1103-1106. 3. Wells RE, Smitherman TA, Seng EK, Houle TT, Loder E. Behavioral and mind/body interventions in headache: Unanswered questions and future research directions. Headache. 2014;54:1107-1113.
............. Funding Source: None.
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HEADACHE CURRENTS
Editorial: Complementary and Alternative Medicine (CAM), Ayurvedic Medicine, and Research Into Behavioral and Mind/ Body Interventions in Headache Stewart J. Tepper, MD
This issue of Headache Currents offers three remarkable and remarkably different articles on nontraditional approaches to Headache Medicine. The articles vary as much as the treatments. Dr. Rob Cowan of Stanford addresses reality in Headache Medicine practice, that is, that patients are taking a potpourri of treatments, some that we prescribe, others that they find out about, and others that are recommended by Complementary and Alternative Medicine (CAM) practitioners. Dr. Cowan’s article is not a literature review. Rather he states, “Perhaps it is time to reconsider whether we are acting in our patients’ best interests by discounting (or worse, dismissing) treatments not objectively evaluated. Perhaps, in the absence of these objective evaluations, it is time we gave weight to traditions and clinical experiences that, in some cases, span thousands of years and millions of clinical experiences in the hands of countless non-Western practitioners.”1 He expands on this by considering a case of a patient in his practice who is on a wide group of treatments, some prescribed, some almost unheard of and unregulated. He tracks down some of them, like a detective, in descriptions of classical Chinese healing. Then he tries to give the reader his wisdom, guidance, and recommendations for the future. One of his endorsements is, when possible, to become familiar with some of the alternative systems used in treating headaches. In addition to classical Chinese, he mentions homeopathy and Ayurveda. He states, “Having a referral base that includes some of these practitioners is very helpful. Integrating these approaches into one’s own practice can be even more helpful, but requires considerable commitment in time and refocusing of the practice ... We don’t need to embrace every alternative medical system to serve our patients, but there exists a wide variety of modalities which, whether we incorporate them into our practices or not, need to be on our radar, and with which we need more than a passing familiarity. Moreover, we need to provide some guidance to our patients in these areas if we are truly to be their advocate in healthcare.” For this reason, I asked Dr. Trupti Gokani, who melds Western medicine and Ayurveda in her practice, to provide a description From the Cleveland Clinic, Cleveland, OH, USA. Address all correspondence to S.J. Tepper, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44106, USA. Accepted for publication March 2, 2014. ............. Headache © 2014 American Headache Society
of the Ayurvedic system for this issue, and how she uses Ayurveda in her headache treatments.2 This is an eye-opening review, and it immediately calls to mind Dr. Cowan’s admonition that “Because these are medical systems rather than discrete interventions, studies are much harder to come by and in general, each has its own internal logic. It is much more difficult to evaluate a system which is based on centuries of trial and error or an oral tradition.” I found Dr. Gokani’s summary riveting, and it will help me in talking with my patients who use this approach. The biggest problem in alternative care is squaring these treatments with the Western tradition and the requirement for rigorous evidence-based studies. In the third article in this month’s Headache Currents, Dr. Rebecca Wells and colleagues tease apart the requirements for adequate study in mind/body interventions in headache.3 This article is particularly useful in that the authors tightly organize the questions that remain in evidence-based mind/body interventions, the troubles in answering the questions, and how they might be addressed. The scope of their considerations, the hypotheses they suggest a need to evaluate, and the recommendations for the future are extremely clear and have the potential to be helpful as we proceed forward. Taken together, this is a startling trio of articles, and the accompanying references can help lead the interested reader to wider and varied possibilities in approaching our headache patients. References 1. Cowan R. CAM in the real world: You may practice evidence-based medicine, but your patients don’t. Headache. 2014;54:1097-1102. 2. Gokani T. Ayurveda – The science of healing. Headache. 2014;54: 1103-1106. 3. Wells RE, Smitherman TA, Seng EK, Houle TT, Loder E. Behavioral and mind/body interventions in headache: Unanswered questions and future research directions. Headache. 2014;54:1107-1113.
............. Funding Source: None.
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