Letters to the Editor  |   July 2006
Author Affiliations
    Diamond Headache Clinic Chicago, Ill
    Spaulding Rehabilitation Hospital Boston, Mass
    Diamond Headache Clinic Chicago, Ill
    Palm Beach Headache Center Nova Southeastern University West Palm Beach, Fla
Article Information
Neuromusculoskeletal Disorders / Pain Management/Palliative Care / Headache
Letters to the Editor   |   July 2006
The Journal of the American Osteopathic Association, July 2006, Vol. 106, 424-425. doi:
The Journal of the American Osteopathic Association, July 2006, Vol. 106, 424-425. doi:
It would appear from his statements regarding the series of articles appearing in the supplement to the April 2005 issue of the JAOA1-5 that Dr Wisnioski may have failed to understand the meaning of the word cause. Without understanding the pathophysiologic process that produces the clinical symptoms reflected in a disease state, then such causes that he refers to as “psychosocial and musculoskeletal” would not result in the production of the clinical characteristics that we know as migraine. Certainly, as advanced as Andrew Taylor Still, MD, DO, was in his teachings, so too the advances that have occurred in medicine would not have been lost on him. Without the underlying genetic constitution, it's doubtful that migraine and other primary headache disorders would exist. If the genetics necessary to cause migraine were not required, then every menstruating woman would experience menstrual-related migraine with each menses since the cause, as Dr Wisnioski implies, occurs in all women—a situation that thankfully does not exist. 
Special supplements to the JAOA have strict page restrictions that limit the number of articles to be submitted and the number of words per article. Thus, it would not be possible to cover all the potential clinical and basic science issues that constitute our knowledge of migraine and other headache disorders. Therefore, any such series of articles will be limited in their scope of presentation. Dr Wisnioski's knowledge of the literature is obviously limited, because the issue regarding Dr Biondi's article has been extensively addressed in the journal Headache.6 
Dr Wisnioski infers that we have become more “allopathic” in our approach because we have moved beyond merely holding to tenets espoused 130 years ago. Rather, it may well be that others in the healthcare field have become more “osteopathic.” Certainly, many of the concepts that some osteopathic physicians feel are ours alone are practices and ideas that other healthcare professionals use on a daily basis. These include manual medicine, as well as the holistic concepts that truly unify the basic tenets of osteopathic medicine. The authors of the articles in the JAOA supplement devoted to headache could have consumed not only the entire special issue, but also more pages elaborating on the holistic principles that specialists in the field of headache use to evaluate and treat their patients. 
Addressing the issue of manual medicine, I agree in part with Dr Wisnioski's statement regarding the mixed results seen with this approach, at least when it comes to migraine and headache. I am most disappointed that steps taken by several of the authors of this special supplement have failed thus far in their efforts to promote well-controlled clinical trials of osteopathic manipulative medicine or have met with an uncertain fate at the hands of investigators, thus leaving us with only scientifically poor trials on which to base osteopathic manipulative treatment. 
Dr Wisnioski takes us to task for the “unapproved use” of medications in the pediatric population, whereas the osteopathic medical profession itself promotes: “Only therapies proven clinically beneficial in improving patient outcome should be recommended.”7 Were we to have followed this approach, then the lack of evidence for manual medicine in the management of migraine would suggest, in the logical pursuit of our own tenets, that it not be used. That is something that would be most unwise in my clinical experience. Just as unwise is the concept that only approved indications for drugs be followed in their prescriptive use. If we were to adhere to this guidance, then millions of patients with headache, at the least, would bear the consequences in the form of disability, discomfort, and the likelihood of disease evolution. 
Freitag FG. As the “circle turns round” back to neurovascular basis in migraine [editor's message]. J Am Osteopath Assoc. 2005;105(4 suppl 2):cover 2–S1. Available at: Accessed June 27, 2006.
Hershey AD, Winner PK. Pediatric migraine: recognition and treatment. J Am Osteopath Assoc. 2005;105 (4 suppl 2):S2–S8. Available at: Accessed June 27, 2006.
Nissan GR, Diamond ML. Advances in migraine treatment. J Am Osteopath Assoc. 2005;105(4 suppl 2):S9–S15. Available at: Accessed June 27, 2006.
Biondi DM. Cervicogenic headache: a review of diagnostic and treatment strategies. J Am Osteopath Assoc. 2005;105(4 suppl 2): S16–S22. Available at: Accessed June 27, 2006.
Silberstein SD. Chronic daily headache. J Am Osteopath Assoc. 2005;105(4 suppl 2):S23–S29. Available at: Accessed June 27, 2006.
Biondi DM. Physical treatments for headache: a structured review. Headache. 2005;45:738 –746.
Tenets of Osteopathic Medicine. Available at Accessed May 18, 2006.