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 children^6,7 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.