Dr. David Buchholz published Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain in 2002. While controversial, the book is still the #1 best seller on Amazon for headaches. I checked in with Dr. Buchholz to find out which of his recommendations still stand, which he’s changed his position on, and why he continues to take other doctors to task. In Part 1, we covered his rationale for getting patients off most migraine medications. In Part 2 of this 4-part series, we talk about why he focuses on dietary changes, when other doctors may not.
Why do you think many doctors don’t address diet changes?
There isn’t published research to support a dietary approach. So they cite that as a reason, because we doctors like to think that everything we do is based on science. My clinical experience tells me convincingly that diet works. But, right or wrong, that’s not considered “evidence based.”
Most doctors haven’t implemented an effective dietary approach, so naturally they think it doesn’t work. They might recommend removing caffeine, cheese, chocolate, and/or red wine, but might miss a whole bunch of other triggers in their patient’s diet. Plus, if the patient is still on rebound-causing drugs like triptans, dietary changes are not usually effective in my experience.
I think there may be some darker aspects to it too. Dietary management, which is self-management, is a form of empowerment. How do doctors maintain their position? Primarily by prescribing medications. Surgeons operate. Non-surgical MDs prescribe. So there’s a certain temptation to hold on to your position in this situation.
Many thought leaders in the field are heavily involved with the pharmaceutical industry. So there are reasons why the drug approach carries more institutional weight. But it’s not necessarily in the patient’s best interest.
What if patients say, “But I have tried changing my diet and it didn’t work!”
I go through all the reasons why my dietary approach is likely different to what they have tried:
A) It wasn’t comprehensive enough.
B) They were over-using [inadvertently] rebound-causing drugs which made their body resistant to improvement.
C) They didn’t do it for a long enough period of time.
It’s crucial to understand why dietary triggers go unrecognized:
A) There’s commonly a delay of up to a day or two between intake and effect. [Stephanie’s note: 2-96 hours is the estimate!] B) The impact of a dietary trigger may seem inconsistent because of the varying levels of other triggers from day to day.
C) Caffeine is an apparent paradox, since it may seem to help in the short run but is a major trigger long-term.
D) When you have a headache every day it blurs your ability to see any triggering influence, dietary or otherwise.
Have you changed your position on any of the dietary recommendations you make in the book?