Clincal Briefs-With Comments from John La Puma, MD, FACP
Homeopathy for Headaches and Migraines
April 2000; Volume 3; 48
Source: Ernst E. Homeopathic prophylaxis of headaches and migraine? A systematic review. J Pain Symptom Manage 1999;
18:353-357.
Homeopathy is often advocated as a prophylaxis of migraine and headaches. The aim of this systematic review was to evaluate the clinical trials, testing the efficacy of homeopathy for these indications. Independent computerized literature searches were carried out in four databases. Only double-blind, randomized, placebo-controlled trials were included. Four such studies were found. Their methodological quality was variable but, on average, satisfactory. One study suggested that homeopathic remedies were effective. The other methodologically stronger trials did not support this notion. It is concluded that the trial data available to date do not suggest that homeopathy is effective in the prophylaxis of migraine or headache beyond a placebo effect.
COMMENT
One of the most prolific and scientifically rigorous authors in alternative medicine, Ernst here reviews the as-sumptions of homeopathy. The individual requires treatment, not the disease. Remedies can be simultaneously diluted, shaken, and potentiated. A molecule that causes symptoms in healthy people can treat the same symptoms in ill people.
What is the allure of homeopathic medications? Is it that their names are fun to say (silicea), pretty (belladonna), floral (cyclamen), suggestive (ignatia), or elemental (sulfur)? Or is it that they can be purchased while shopping for groceries, over-the-counter, like teas from a jar? Or that their theory of use is so anti-rational that it attracts those of us who think we have little control over what happens in life anyway, so why not?
Ernst included analyses from MEDLINE, Embase, CISCOM, and the Cochrane library, and whittled 400 publications down to four, totaling fewer than 300 patients, most of whom had migraine headaches, variably defined. Treatment lasted an average of 12 weeks; follow-up ranged from 12 weeks to five months. Results were mixed: Two trials were positive, and two were negative, and the latter two were the strongest trials methodologically.
Ernst speculates that a substantially longer treatment phase or a substantially higher dosage might be needed to see effect. He also acknowledges that homeopathy might only be as good as placebo for headaches (which is probably the case).
Recommendation
Advise patients with headaches to save the money they would spend on homeopathic remedies—they do not appear physically harmful or more effective than placebo.
April 2000; Volume 3; 48
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