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A randomized trial on the effects of regular water intake in patients with recurrent headaches

PainSci » bibliography » Spigt et al 2012
Tags: treatment, water, controversy, debunkery

Two articles on PainSci cite Spigt 2012: 1. The Complete Guide to Chronic Tension Headaches2. Water Fever and the Fear of Chronic Dehydration

PainSci commentary on Spigt 2012: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This study testing the effect of drinking extra water on headaches is the only one of its kind ever done as far as I know. It produced a perception of improvement with an extra 1.5L of water per day, and the way it’s summarized by the researchers you could easily mistake this for a positive result. But perception of improvement is a secondary outcome. As for the primary outcome: well, uh oh, there was actually no objective effect on anything that mattered: “Drinking more water did not result in relevant changes in objective effect parameters, such as days with at least moderate headache or days with medication use. There was no significant effect modification for headache intensity at baseline, age, gender, migraine, migraine with aura and tension type headache.”

So the perceived improvement was almost certainly just wishful thinking on the part of the experimental subjects, who had “significantly more positive expectations.” These results are actually evidence that hydrating does not help headaches. •sad trombone•

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Previously published investigations suggest a positive effect of increased water intake on headache, but a randomised controlled trial has not been done.

OBJECTIVE: To investigate the effects of increased water intake on headache.

METHODS: Randomised controlled trial in primary care with two groups and a follow-up period of 3 months. Patients were included if they had at least two episodes of moderately intense headache or at least five mildly intense episodes per month and a total fluid intake of less than 2.5 l/day. Both groups received written instructions about stress reduction and sleep improvement strategies. The intervention group additionally received the instruction to increase the daily water intake by 1.5 l. The main outcome measures were Migraine-Specific Quality of Life (MSQOL) and days with at least moderate headache per month.

RESULTS: We randomised 50 patients to the control group and 52 patients to the intervention group. Drinking more water resulted in a statistically significant improvement of 4.5 (confidence interval: 1.3-7.8) points on MSQOL. In addition, 47% in the water group reported much improvement (6 or higher on a 10-point scale) on perceived intervention effect against 25% in the control group. However, drinking more water did not result in relevant changes in days with at least moderate headache. «And that’s the outcome that actually matters.»

CONCLUSIONS: Considering the observed positive subjective effects, it seems reasonable to recommend headache patients to try this non-invasive intervention for a short period of time to see whether they experience improvement.

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