Ian Cheong wrote:
Just ask google - get an answer in seconds rather than days:
http://www.headache.com.au/hachehtm/faqs/migfaq.html
In the absence of any quoted actual research or source of the
information, I tried to see who the author of the claims on this site
is. I couldn't find that information in the links, but did find a
clickable map of Australia from the 'practice directory' button in the
left side bar, in which the South Australia part showed me the details
of an optician's practice and a pair of chiropractors.
Lots of hits for migraine swapping sides, even during an attack.
The thing that really interests me about this is not so much whether
migraines have ever been known to swap sides, but the *difference*
between all the statements (including Therapeutic Guidelines') that
migraine tends to swap sides, and my own experience in which I have not
seen this happening. So far Horst reports similar experience and I will
take the silence from everybody else so far as silent agreement with
my case that migraines do not tend to occur on alternate sides.
I wonder whether this claim about swapping sides arose because somebody
who was seen as authoritative once said so, and that that statement has
been repeated ever since without examination, challenge or attribution?
I suspect that this has happened more than once in medicine. For
example, Sir Humphrey Seenalot states that the major cause of
haemorrhoids is constipation. Sir Humphrey does not produce any
evidence or research - he is an eminent haemorrhoidologist who has
treated a lot of people with haemorrhoids and he just says so. He even
has said so in his textbook of haemorrhoids, which is the standard work
in the area. For the next fifty years, everybody else quotes this as a
fact.
The migraine swapping sides idea has the appeal also of a) sounding like
an interesting fact, and b) sounding as if it should be a useful
diagnostic criterion (even if it is not).
We all (the profession and the public) love interesting facts, such as
the statement that women ovulate from alternate ovaries. I don't know
whether this is true either, but at least it sounds interesting.
In the profession we are always looking for anything that helps us to
diagnose and differentiate conditions, so the swapping sides statement
is attractive for that reason.
Makes logical sense to me...why would a vascular phenomenon that is
physiological/biochemical rather than anatomical be anatomically selective?
I don't have any problem with accepting that migraines may occur on
either side at different times in any one patient. It is the statement
from TG that implies that migraine usually or always swaps sides between
attacks that I am challenging.
(Quoting Ken Harvey on 27/4/06 quoting TG: "Attacks of cluster headache
are much shorter in duration than (untreated) attacks of migraine, and
unlike migraine the headache does not swap sides between attacks.")
--
Oliver Frank, general practitioner
255 North East Road, Hampstead Gardens, South Australia 5086
Phone 08 8261 1355 Fax 08 8266 5149 Mobile 0407 181 683
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