Migraine prevention

We're always looking for new approaches to migraine prevention. I saw a patient this week who was in the hospital with a headache. Here is a close-to-verbatim fragment of the interview:

"Have you had headaches before?"
"Yes, many years ago I was having a lot of migraines. They went away after I got divorced."

Something in the category of now-that's-funny-but-neither-of-us-laughed.

But wait a minute...is there something more here? Is this worthy of further study?

Proposed study: Migraine prevention through interruption of marital contracts

Objective: To determine if marital divorce results in significant relief from frequent headaches

Study population: Married patients of either sex with headache at least twice a week and evidence of significant marital discord, as evidenced by a) frequent thoughts of ending the marriage, b) recurrent verbal threats to end the marriage, or c) actual prior periods of separation. A scale will be developed to score this degree of discord. There may be some need to raise the levels of these indicators in case these features apply to more than 75% of the married population. An initial target population of 100 in each of the interventional and control groups will be sought. It is anticipated that, depending on demand, geometric multiples (1,000 or 100,000) may be feasible. In this case, copyright clauses may be invoked for the purposes of establishing a commercial franchise operation.

Exclusionary criteria: a) Separation due to legal circumstances (i.e., court order or incarceration), since these situations are felt to likely add confounding stress variables for subsequent analysis. b) marital discord accompanied by physical trauma, since this may result in traumatic sources of headache.

Special circumstances: Although not excluded, non-heterosexual marriages, where permitted by law, will be kept in a separate group for analysis purposes.

Study procedure: A baseline headache frequency will be determined for six months, after which couples will be randomized to a) divorce or b) continued cohabitation, and be analyzed for an additional six months. The cost of simple divorce proceedings will be paid for by the study. If the number of subjects permits, a third group of c) separation-without-divorce may be created. Other migraine treatments will continue throughout the study period, with subjects keeping an accurate tally of headaches and doses of medication for individual headaches. If spontaneous divorces occur during the baseline observation or after randomization, age and conflict matched controls will be allocated.

Primary endpoint: Significant reduction in headache frequency and/or severity. This might be typified by a statement such as, "I knew (s)he was a pain in the ass, but I never realized that this marriage was the real source of my migraines."

Secondary endpoint: Continued headaches but other positive benefits, as typified by, "You know, I always thought that my headaches were a major problem, but now that I've gotten rid of that jerk, I feel like I can deal with them."

Now to seek the funding.