More migraine headaches caused by cleaning products: from N=1 to N=2

Seth Roberts has an update to the piece he wrote for Boing Boing about a woman who cured her migraines by getting rid of cleaning products.

At Thursday’s Quantified Self Silicon Valley Meetup (where I gave a talk called QS + Paleo = ?), Alexandra Carmichael introduced herself with the three words “no”, “headache”, and “today”. About five days earlier, she had started having migraine headaches every day. Before that, she hadn’t had a migraine headache in a year. After the headaches began, her husband, having read my Boing Boing story(about a woman whose migraines were mostly from cleaning products), suggested that her headaches might be caused by theFebreze they had just started using. They stopped using it. Because it can linger in carpets, etc., they cleaned their whole apartment with vinegar and baking soda, to get rid of all traces. That’s when Alexandra’s headaches stopped.When they started using Febreze, one of their daughters became very cranky. After they stopped using it and cleaned their apartment, she returned to her usual self.

More Migraine Headaches Caused by Cleaning Products: From N=1 to N=2

Mark Frauenfelder is the founder of Boing Boing and the editor-in-chief of MAKE and Cool Tools. Twitter: @frauenfelder. Come and hear Mark speak at the ALA conference in Chicago on July 1.

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Snig

>800k google hits for migraine and Febreze, a quick sampling suggests it’s causing, not curing. A couple links from some seemed to suggest it’s the one non-migraine causing cleaning product for them. Still very individual.
- mtdna
  
  You know what gives me headaches? Hearing people blather on, making
  ardent arguments based on the personal accounts they’ve read on the
  internet.
  
  If we want to turn to Google hits for what we believe, we get:
  
  850 thousand hits for “Febreze causes migraines”
  31 million hits for “I saw a UFO”
  77 million for “Obama is a Muslim”
  1.1 million for “The moon landings were a hoax”
  2.5 million for “Perpetual motion is real”
  
  And last but not least,
  
  205 million hits for “Everything you read on the internet is true.”
  
  Maybe Febreze causes migraines and maybe it doesn’t, but don’t waste our time with these dim-witted arguments.
  - Smash Martian
    
    According to something I read on the internet, stress can trigger migraines too.
  - jtegnell
    
    Three short sentences is blathering on?
  - wrybread
    
    > but don’t waste our time with these dim-witted arguments.
    
    Speak for yourself! If this is helping people, awesome. And if it annoys you so much, doubly awesome.
    
    And by the way, only a dimwit would perform those searches without putting the phrases in quotes. The real results are:
    
    0 hits for “Febreze causes migraines”
    775,000 hits for “I saw a UFO”
    4,660,000 hits for “Obama is a Muslim”
    80,500 hits for “The moon landings were a hoax”
    2,230 hits for “Perpetual motion is real”
    85,100 hits for “Everything you read on the internet is true.”
    
    Thanks for trolling though!
    - mtdna
      
      0 hits for “Febreze causes migraines”? Maybe we can trust the internet after all!!
  - Snig
    
    You know who figures these things out? Doctors who’ve found anecdotal evidence, discussed it and then did research. You know who I am? A doctor who’s published research. I also work with patients who have frequent or daily headaches, who’ve been to headache clinics, who’ve gone through the gamut of meds, have had trigger point injections, botulinum toxin injections, nerve blocks, sinus surgery and radiofrequency ablation. I think if my exhaustive post traumatized you, there’s something else bothering you. Tell me what’s wrong.
  - Mark_Frauenfelder
    
    Thanks for your ardent argument, mtdna!
Spriggan_Prime

I got rid of headaches (and many marital disputes) by getting rid of cleaners as well!
…and hiring a cleaning service.
http://www.mrericsir.com MrEricSir

Cleanliness is close to godliness. And if gods have frequent migraines, that explains a lot.
sinewave42

It’s not implausible that cleaning products could cause migraines – I tend to get headaches when working with volatile organic solvents, and I don’t think that’s particularly unusual – so some people could be more sensitive. That said, can’t draw any conclusions from N=2
DimeSpin

Migraines are weird and migraine triggers are varied, what else is new?
http://www.facebook.com/michael.valera.s Michael Valera

My migraines can be triggered by fairly different things. Strong artificial favors, colorants (ie: fruit flavored hard candies, or orange/grape sodas), some sweet non-natural scents also give me instant migraines like plug-in candles and incense to some extent make me cranky. Being inactive and very bored also seems to trigger migraines at times.
http://www.facebook.com/people/Samuel-Thompson/1616498638 Samuel Thompson

For me it’s Dial soap. One whiff and it’s like an icepick to the eye socket.
MrScience

After having to finalize the estate of a relative (clean out a hoarder’s apartment) that was a heavy smoker and febreeze user, I take umbrage at the categorization of Febreze as a cleaner. It didn’t cover up the smoke scent, and instead had glued dust to everything in the apartment. The smell was noxious.

I ended up purchasing the expensive, but very worth it, Zero Odor at a nearby Bath & Beyond. That stuff was amazing, destroying both the smoke and Febreze scent. And the patents (mostly from food prep industries) were quite fascinating to read.
Jason Sutor

Neat! I was there
For silicon valley folks interested in Quantified Self the meetups are at:
http://www.meetup.com/quantified-self-silicon-valley/
and the overall quantified self movement is at:
http://quantifiedself.com/
asuffield

Sugar pills are highly effective at curing migraines.

It’s a condition with a massive placebo effect and this is not a random controlled trial. So this is worse than meaningless (because now a bunch of people will go around believing it, making them slightly less rational than they previously were).
dragonfrog

It seems like a no-brainer that products like febreze cause migraines in some people – various solvents give lots of people slight headaches. In my case, notably whiteboard markers (a PITA given how widely they’re used at my work).

Can’t speak to febreze, as it’s already banished from our house for a completely different reason – it irritates my wife’s skin.
Neural Kernel

Since when is febreze a “cleaning product”? I always figured it was a “spray this so you can put off cleaning for a bit longer” product… that and a “crap, mom and dad are home early!!” product :P
waitingforvizzini

Anecdotes do not make for good science. However, having said that, migraines are well-known to have many, many triggers – sufferers are often sensitive to scents, noise, chemicals, foods. Name something affected by your five senses and it can affect a migraine sufferer. The key for living with and “curing” migraines is for the person who is living with them to keep track of when a migraine occurs and what happens before, during and after. What foods have been eaten? What products have been used? What kind of environmental factors are in play? What kind of hormones might be at work (especially for women)? What other drugs (prescription, OTC or herbal) are being taken and have helped or hindered? While some doctors are more helpful than others, they can only help a patient based on the information provided – so migraine sufferers should go armed not with information gathered from the internet, but with information gathered about themselves. Tracking and investigating their own symptoms will be the best weapon against migraines. Then, find a doctor or a team of doctors who will work with them over a course of several months (make no mistake, it will take time to be sure the treatment is working) to find a treatment plan that works. Few people find a quick fix or a magic cure. Avoiding migraines requires effort – but it can be done.
Phoc Yu

It could just be a smell sensitivity And not the actual ingredients. I can’t walk by certain stores in a mall without getting nauseated, dizzy, and sometimes feeling faint. And not just the floral and fruity soap/candle stores, but some clothing stores as well. Lasting migraines only come when I have to walk into one of those stores to retrieve a loved one.
http://www.facebook.com/profile.php?id=673021681 Twm Davies

The plural of anecdote is not evidence.

The last part isn;t even to do with migranes:”When they started using Febreze, one of their daughters became very cranky. After they stopped using it and cleaned their apartment, she returned to her usual self..”

Great, some people may be finding ways of reducing their headaches. But as discussed before, looking for individual stressors and triggers should be part of the medical ‘work up’.
Seth’s quote about ‘doesn’t fit in the standard healthcare system’ is simply not true. It can and should fit in the standard healthcare system.
Just because Seth’s subjects have had [n=2] experiences with health care system does not make their experience representative of every medical encounter.

This whole N=1 business feels like a dig at and a misrepresentation of science and medicine. And articles which talk about a ‘cure’ like this are very daily mail.
Science starts with people noticing patterns and a forming a hypothesis. Here the hypothesis is ‘ferbreze causes headaches in some people’ which is where well designed studies can help shed light.
Most discoveries in medicine were based on observation of patterns made on small number N, which then gets further scrutiny by proper studies.

There are many interesting questions that are not even touched on:
Which febreze product, was it the room spray, plugin, fabric product?How much febreze does a person generally use? Were these people excessive users? Is there a dose related response?Did they follow the instructions on the box? is there a particular ingredient that can be isolated. Did they give something else up at the same time, e.g other cleaning products.I’m a great admirer of self experimentation (see Michael Mosely’s ‘Medical mavericks’ BBC series for a enlightened if disturbing account of the practice). It can be a useful tool for the individual and a starting point for making a rigorous case for the rest of us, but a balanced piece would re-iterate the problems of drawing conclusions from individuals, especially second or third hand anecdotes.
- Antinous / Moderator
  
  The plural of anecdote is not evidence.
  
  Parroting a meme is not intelligent discourse.
  - jeraliey
    
    Relevant application of a valid concept is not parroting a meme.
    - Antinous / Moderator
      
      Much of the evidence in medicine consists of anecdotal data from patients. If you know of a practical way to determine whether or not someone has pain other than to elicit an anecdotal response, I’m fairly certain that you have a trip to Sweden in your future.
      - jeraliey
        
        As a physician who has been trained in evidence-based medicine, I’d like to point out that there is a hierarchy of evidence quality that is considered when determining which data will guide practice.
        
        Here is the ranking from the US Preventative Services Task Force:
        
        Level I: Evidence obtained from at least one properly designed randomized controlled trial.
        
        Level II-1: Evidence obtained from well-designed controlled trials without randomization.
        
        Level II-2: Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
        
        Level II-3: Evidence obtained from multiple time series with or
        without the intervention. Dramatic results in uncontrolled trials might
        also be regarded as this type of evidence.
        
        Level III: Opinions of respected authorities, based on clinical
        experience, descriptive studies, or reports of expert committees.
        
        Any recommendations based on anecdotal evidence are clearly labeled as anecdotal…usually with a note that it will require more study before it can actually be used as a recommendation.
        
        I believe when you’re using the term “anecdotal evidence”, you mean “information obtained from a specific patient”. I agree with you that that is very, very useful and relevant information…..but only for the specific patient in question.
        
        The problem here is the idea of generalizing from non-applicable particulars. It’s dangerous.
        
        Where does Sweden come into this, please?
      - Antinous / Moderator
        
        I believe when you’re using the term “anecdotal evidence”, you mean “information obtained from a specific patient”. I agree with you that that is very, very useful and relevant information…..but only for the specific patient in question.
        
        When a dozen of your patients who are on Fixitol complain of dizziness and it’s not listed as a side effect, don’t you report it so that the FDA can investigate? A number of anti-depressants that worked well in clinical trials have turned out to be useless or deleterious in long-term use. You would rate that as Level III, but it’s more valuable than the Level I evidence for those drugs.
      - jeraliey
        
        Yes. Which is why medicine is not a static field. I don’t know a single treatment in use that isn’t currently being investigated repeatedly, from all sides, right now. No matter how old they are or what the original studies stated. New evidence always comes up, refuting and refining the old.
        
        This is why they call medicine an art as well as a science. People aren’t identical, and medicine isn’t perfect, and what we’re using for information changes on a DAILY basis. It’s the responsibility of a good doctor to take all of these factors, work with each individual patient on an individual basis, and come up with a solution that works…if there is one. If not, come up with the next best thing, and keep trying until you can approximate an acceptable outcome.
        
        I’d love to hear a better way. I don’t think it’s crowd-sourcing, because I’m really sick of cleaning up the messes that the internet makes of my patients’ physiology when I see them in the Emergency Room.
        
        Anyone can give medical advice over the internet. But please forgive my frustration with stuff like this, as I am the one who has to make sure the consequences don’t kill people.
      - asuffield
        
        Much of the evidence in medicine consists of anecdotal data from patients.
        
        This is not an anecdote: the metastudy of randomized controlled trials that I linked earlier proved that if you give people with migraines a placebo then around 23% of them get better.
        
        So, if they all acted like this article proposes, then a lot of people would make blog posts saying “I removed [irrelevant product] from my life and I am cured, so this product causes migraines”. It should be clear why this anecdotal information is of no practical use; you have no way to distinguish between those who have found a real problem and those who have just convinced themselves.
      - wrybread
        
        I don’t think anyone is suggesting that anecdotal accounts should replace the scientific method. I think the point is that people communicating with other people who have similar symptoms might, occasionally, be able to make progress in helping themselves.
        
        And the ability to do that is really new. The social internet is a very young beast.
      - trieste
        
        Bringing people with similar anecdotes together is also the root of the anti-vaccination network and look at the money wasted and lives lost with that social internet experiment.
      - Snig
        
        You think there’s a strong similarity between my wondering how many people on the internet complain about febreze as a migraine trigger and vaccine avoidance? Will I be patient zero in many ER cases of Febreze Deprivation Syndrome? My pretty vague post mentions some people saying it bothers them, others that it’s the one thing that doesn’t trigger their migraines. I think if I suggested we besiege Proctor and Gamble with pitchforks and torches, or to not buy Febreze, that would be one thing, but I think rambling musings on the internet, even about health, are OK.
        
        I NEVER suggest people forgo medication without very strong reason, especially life saving ones.
      - PJDK
        
        “Much of the evidence in medicine consists of anecdotal data from patients. If you know of a practical way to determine whether or not someone has pain other than to elicit an anecdotal response, I’m fairly certain that you have a trip to Sweden in your future.”
        I’ve got to jump in here. That isn’t anecdotal that is subjective. There is no outside measure of how severe a migraine is. But if you take a large group of people and measure how they respond the inaccuracies of that subjectivity drop out in the sample size.
        
        Anecdotal evidence is “well I just had this experience so maybe everyone else will too” which is completely different, and could easily relate to a measurable condition like the extent of a rash.
        
        “When a dozen of your patients who are on Fixitol complain of dizziness and it’s not listed as a side effect, don’t you report it so that the FDA can investigate?”
        
        This is a slightly different thing again. And more similar to a study, since doctors are looking out for side effects in a sample size of all patients. Side effects are a bit easier to measure too since they are unexpected events. If you have a headache it will in all likeliness go away. If you have a headache, take a pill and then grow a third arm the causal link is easier to establish.
  - Jonathan Badger
    
    It’s not a “parroting a meme” — it’s understanding how science works. And the fact that people keep on thinking their anecdotal experiences are anything more than random coincidences suggests that people, in general, *don’t* understand how science works.
mtdna

Touche Mark. I’ll stop trolling. Let me also say, as an occasional (fortunately) sufferer of migraines myself, that I do sympathize with people who have major struggles and understand their eagerness to investigate any possible solution. The possible solution to the Febreze thing is so simple and non-invasive – don’t use it – who cares if the evidence is only anecdotal?

Added: Did you know Oliver Sacks’ first book was on migraines? (Migraine, ISBN 037570406X)
- wrybread
  
  Seems to me that you’re now making an equally pig headed argument: whereas it was “shut up you’re wrong”, now it’s “shut up what you’re saying is obvious”.
  
  To me the interesting point here is that the internet has given people with hard to diagnose issues a way to collaborate and identify patterns so they can heal themselves, or at least find ways of coping. Before the internet they may have been told by their doctor either that there was nothing wrong with them, or that there was nothing that could be done. Now people can take more of an active role in healing themselves. In this specific example, maybe someone suffering from migraines would want to cut out cleaning products to see if it helps.
  
  Why is that so hard to understand?
  - mtdna
    
    You’re right wry. I apologize. I’ve just gotten skeptical about this kind of thing ever since I read this article in the news: http://www.theonion.com/articles/internet-opens-up-whole-new-world-of-illness-for-l,1493
    
    Added: Sorry – I said I’d stop trolling. Now I really promise.
manooshi

It has long been researched and is a well-known scientific fact that extreme sensory stimuli can trigger migraines, from light, to sound, to smell, etc.

I’ve been a migraine sufferer for most of my life. My migraines truly suck sweaty, hairy, smelly balls. I’ve been through three painful surgeries and a migraine is more painful than any of those experiences.

Febreeze and Bounce Dryer Sheets trigger instant migraines for me. So do those Glade Plug In Candles. I FUCKING HATE ALL THREE of those products and wish they were fully banned for being synthetic-fragrance/piece of shit/toxic chemical instant migraine triggers!!! I’m sorry, but if you use any of those three products, then you’re an ignorant and toxic asshole in my eyes!

Incense triggers migraines for me as well. Cigarette smoke = migraine-trigger sticks from HELL. And strobe lights were created by the devil.

Food preservatives and nitrates trigger my migraines also.

Unfortunately, most alcohol, as well, especially the “darker” ones.

Basically, the more “natural” something is, ie: the less a product is artificially derived, synthetically-based, and/or chemically polluted/preserved – the less likely it will be a migraine trigger.
bpratt

I don’t get migraines but I still don’t choose to fill my house with nasty industrial chemical vapors like Febreze and Glade and Lysol and god knows what. I’ve never understood why people unleash that shit on themselves.
http://www.facebook.com/profile.php?id=657306006 Mark Stewart

I started using Febreze and the only symptom I suffered was a clean and fresh smelling house. Granted, I am a troll, so my place stunk like crap anyway.
/science needed for both sides of this tennis game.
catgrin

I’m one of those chemically-sensitive types who tries to avoid strong cleaners. Pine Sol, one of the worst triggers for me, will send me from a room with tears streaming down my cheeks as I wheeze and gasp. Even when used three rooms away it will irritate my sinuses and cause a headache. It’s permanently banned from any home I live in.

The people who are reacting to Febreze may either be reacting to the propellents in the spray cans or to specific scents used. I don’t react to the original formula’s scent (which mostly goes away once dry), and occasionally do use it to clean very dusty things (including some l.p.s that sat through a flood) or before I vacuum any upholstered furniture. I have a bad dust allergy (level 4 out of 5, bad enough that I wear gloves to dust), and dampening the dust lets less into the air.

Febreze Allergen Reducer (the original scent) is the only product in their line which claims “Dermatologist Tested” and the only one I use. It comes in a pump, not under pressure. Here are a few other scents that Febreze uses now that they’ve expanded their product line: lavender, orange oil, and jasmine – all common allergens, and not surprising triggers for reactions. None of febreze’s products are claimed or marked as hypoallergenic.
Drabula

this is why i choose to live in filth
- Antinous / Moderator
  
  this is why i choose to live in filth
  
  Funnily enough, my place is filthy right now because my sinuses have been acting up and I don’t dare do anything that would stir up the dust.
Snig

And speaking of vaccinations, I will point out that Edward Jenner was famously tooling through the internet looking for images of dairy maids when he came across the folksy observation that dairy maids didn’t get small pox. He then sensibly did the next logical thing, and injected himself and his family and thus avoided smallpox. The legends that he actually was googling for “hairy maids” and committed an excited typo are just unkind rumours that do not bear repeating.
ziz

Huge numbers of artificial scents – basically everything in the scented detergent / soap / body product category, most scented candles, most air fresheners and similar products, and every perfume I’ve ever smelled – trigger migraines for me. Some of them do so incredibly quickly, and some take five or ten minutes of exposure.

For a long time, there wasn’t a treatment that was effective against my migraines, and I’d more or less just curl up and sob until I fell asleep and hope that I’d either feel better or be dead when I woke up. Sadly, often I was neither, and I’d be useless for several days. I was getting these migraines, for reference, at least three times a month.

Doctors tried all manner of things; I tried all manner of things. The availability of Imitrex (Sumatriptan, which Wikipedia tells me was the first clinically available triptan in the US) was an amazing breakthrough; suddenly a migraine that would have crippled me for two or three days was a two-*hour* ordeal instead.

It turns out that one of the most significant triggers for my migraines was…fear of migraines. Worrying and stressing that I was going to have another migraine made many triggers much more likely to actually trigger a migraine. These days, I have a migraine about once every three or four months, and I take my medication and lie down and suffer…well, not happily, but at least secure in the knowledge that I have an almost-entirely-effective treatment.
Space Toast

I fear that anecdote-as-medical-advice is going to become to BoingBoing what climate change denialism has to Slashdot. The combination of at least one sympathetic moderator and a contingent of vocal supporters tends to set up a feedback loop where the site becomes a refuge for the fringe idea. As the Huffington Post is already well out ahead of BB on the shoddy medicine front, can we perhaps leave it to them?
- Antinous / Moderator
  
  If you can’t tell the difference between anti-vaccine campaigners and my suggestion that long-term observations by physicians might have as much value as short-term clinical trials, then you might want to examine your own logical processes.
manooshi

Why are so many people saying that it’s only anecdotal stories, and hence unscientific, that most migraine sufferers agree that artificial scents trigger migraines? My neurologist does not believe that this is just an anecdotal/unscientific coincidence.

It makes me wonder whether these harsh “skeptics” work for Fabreeze, Bounce, Glade, and/or some other artificial scent producing toxic product/company.

Also, has one noticed how allergies have dramatically risen since everyone has put these artificial scents all over everything? These harsh chemicals/artificial scents may not only be migraine triggers, but allergy triggers as well.
Snig

I’m curious how the “maybe going without Fabreze if you have migraines” discussion got to be more controversial then the “hey we don’t need soap” discussion.
- jeraliey
  
  It’s because you’re recommending an intervention for a medical condition based on an N of 2. And this site is read by scientists.
  
  It’s not the Febreeze concept people are objecting to, necessarily. It’s the bad science, presented as if it means something.
  
  Observation is only the first step of the scientific method. You’ve skipped the rest of it, presented your initial observation as your conclusion, and seem to be surprised that people have a problem with that.
  
  There is nothing special about this observation that exempts it from the same burden of proof that any other claim has to support. Do a high-powered, peer-reviewed, well-designed clinical trial….and maybe people will take this seriously.