Thursday, August 16, 2012

Headache? Drink Lots of Water, Researchers Say.

Headache WaterFor persons suffering numerous headaches each month, researchers found that drinking an additional 6 glasses of water each day could ease the pain and improve quality of life. However, while news media thought this was a terrific idea, there were some limitations of this research that might temper enthusiasm for the approach.

Writing in the journal Family Practice, researchers from the Netherlands report a randomized controlled trial in a primary care setting on the effects of increased water intake in patients with recurrent headaches. There were 50 patients randomized to the control group and 52 patients to the water intervention group. Patients were included if they had at least 2 episodes of moderately intense headache or at least 5 milder episodes per month and a total fluid intake of less than 2.5 Liters per day (about 85 ounces).

Both groups received written instructions about stress reduction and sleep improvement strategies. The intervention group additionally received the instruction to supplement their usual daily fluid intake with 1.5 Liters of water (about 50 ounces or roughly six 8oz glasses) each day during the next 3 months. The main outcome measures were scores on the Migraine-Specific Quality of Life (MSQOL) questionnaire and days with headache per month.

Drinking more water resulted in a statistically significant improvement of 4.5 points (95% Confidence Interval: 1.3–7.8 points) on the MSQOL. In addition, 47% in the water group reported much improvement (6 or higher on a 10-point scale) regarding perceived intervention effects compared with 25% in the control group. However, drinking more water did not result in relevant objective changes in the number of days with at least moderate headache.

The researchers conclude that, considering the observed positive subjective effects, it seems reasonable to recommend that patients with headaches should try this simple, inexpensive, and noninvasive intervention for a short period of time to see whether they experience improvement.

COMMENTARY: The recommendations of this study seem reasonable, since regular intake of water and adequate hydration are generally healthy and many people feel better as a result. It is possible, however, that the subjective benefits measured in this study were due in large part to placebo effects.

Other limitations of the research also should be noted. Patients included in the study were not required to be suffering from dehydration at the outset and, for some persons, adding about 6 glasses of water each day onto the usual daily intake might be a lot of water. There were a considerable number of participants (27%) lost to followup in an already small-scale trial, possibly due to dissatisfaction with the daily chore of drinking so much water.

The researchers used an index, the MSQOL, which is validated for assessing migraine, as its name suggests, but it was used for all headaches in this study and internal validity of this measurement might be questioned. Still, based on MSQOL scores, as well as subjective perceptions of improvement, the researchers declare the intervention a success. However, there was no improvement on the objective measure of number of days with headache, and this lack of clinical relevance of importance to patients is disappointing.

Therefore, it seems that this evidence alone is inadequate for recommending that patients drink additional water as an intervention to prevent headaches. Although, based on the study participants’ favorable subjective impressions, advising patients with recurring headaches to remain adequately hydrated might be somewhat helpful and would be consistent with accepted medical practice.

REFERENCE: Spigt M, Weerkamp N, Troost J, et al. A randomized trial on the effects of regular water intake in patients with recurrent headaches. Fam Prac. 2012;29(4): 370-375 [abstract here].

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