There is no debate about the fact that there is an epidemic of vitamin D deficiency in the United States – it affects about two thirds of the population. However, it is bewildering why scientists are still debating if people should be taking vitamin D supplements. You would think that this is a pretty obvious, common sense conclusion. But common sense is far from common, especially in academia (and obviously not just in medicine – it is much worse in the “soft” social sciences).

Two major studies published in the highly respected British Medical Journal reviewed studies that involved data on more than a million people. Both studies showed that vitamin D provided significant benefits. Vitamin D appears to protect against major diseases. Adults with lower levels of vitamin D had a 35% increased risk of dying from heart disease,14% greater risk of dying from cancer, and a higher risk of dying from any cause. Taking vitamin D reduced the risk of dying from all causes by 11%. The authors estimate that 13% of all deaths in the US are due to low vitamin D levels. This is an astonishing discovery, on the par with the discovery that aspirin dramatically reduces the risk of different types of cancer.

So, a reasonable person would expect the medical community to begin recommending vitamin D supplementation, at least for those with low levels. But here is what one of the authors said:: “Based on what we found, we cannot recommend widespread supplementation”. He called for more clinical trials to prove beyond any doubt that taking vitamin D is a good idea. These trials usually cost many millions of dollars and take many years to complete. How much does it cost to take 2,000 units of vitamin D3 daily? One dollar a month. And what are the potential side effects of taking 2,000 units of vitamin D? None.

The bottom line is, if your vitamin D level is below 40, take 2,000 units a day. Some people may need higher doses if their levels remain low, which is not unusual. The normal range is considered to be between 30 and 100, but there are studies indicating that you are safer with a higher level. One such study showed that attacks of multiple sclerosis are less likely if you have high normal rather than low normal levels. We do not know if taking vitamin D prevents migraines and other types of headaches (such a study does need to be done), but we do recommend to everyone whose vitamin D level is low to get it up to normal range.

Botox is the most effective preventive treatment for chronic migraine headaches. It is also the only treatment approved by the FDA for this condition, which affects 3 to 4 million Americans.

Despite the wide use of Botox for cosmetic indications, many people still have unfounded fears of this procedure. Some are afraid of the fact that it is a toxin and indeed, in large amounts it is deadly. However, acetaminophen (Tylenol) kills over 500 people every year, which is significantly more than all the deaths from Botox given to millions of people in over the 25 years that Botox has been on the market. There has been no deaths reported when Botox was used for headaches or cosmetic reasons. Botox is not free of side effects, but they tend to be mild and transient.

Another fear is that the procedure is painful and very unpleasant. I recorded this video of me injecting one of my patients (with her permission) so that you can see what the procedure looks like. It took me 3 minutes and 41 seconds from start to finish and, as you can see, with little discomfort.

New risks of Prilosec (omeprazole), Nexium, and other similar drugs (so-called proton-pump inhibitors, or PPIs) are being highlighted by the FDA. They can increase the risk of Clostridium difficile-associated diarrhea, a serious infection. This probably occurs because lowering stomach’s acidity allows this bacterium grow more easily. In additional to watery diarrhea, this sinfection causes abdominal pain, and fever, especially after recent antibiotic use. This as another reason to try to limit the use of PPIs. Their use is also associated with a small increase in the risk of pneumonia, bone fractures, vitamin B12 deficiency, and magnesium deficiency. Having diarrhea from a bowel infection will worsen these deficiencies. It is not easy to stop a PPI because heartburn and other symptoms will first get worse, due to “rebound” increase in acidity. This is why once you start taking a drug like Prilosec, it is very difficult to stop. The way to do it is to first lower the dose, then extend the dosing interval to every other day, every third day, etc. Temporarily taking an H2-blocker (Zantac, Pepcid) and antacids can also help in getting off PPIs. PPIs include Prilosec, Prevacid, Protonix, Nexium, Dexilant, and Aciphex.
What does this have to do with headaches? PPIs can sometimes cause headaches directly, but more often they worsen migraines by interfering with the absorption of magnesium and other vitamins. This is a class effect, so switching from one drug to another will not help. Taking a magnesium, vitamin B12 and other supplements may help, but many of my patients, especially those who cannot stop the PPI medication require an intravenous infusion of magnesium and an injections of vitamin B12.

Migraines are often mistaken for sinus infections, and are treated with antibiotics. The reson for this confusion is that migraines can cause pain in the area of sinuses and some people will even have a clear discharge from their nose during a migraine attack. Sinus infection is really easy to diagnose – it usually causes a yellow or green discharge from the nose. But even if you do have a true sinus infections antibiotics are usually unnecessary because the infection is caused by a virus and viral infections do not respond to antibiotics. This well-know fact is confirmed in a new study which was just published in the Journal of the American Medical Association. The study involved 166 adults with a sinus infection who were given either a placebo or an antibiotic for 10 days. There was no difference between the two groups in the satisfaction with the treatment, the amount of time missed from work, and every other parameter measured. The authors (doctors at Washington University in St. Louis) do recommend starting antibiotics if the condition does not after 5 – 7 days.