BBC1 Doctor in the House, letter of complaint

Dear members,

Below is the joint response from OUCH (UK) and The British Association for the Study of Headache, sent to the BBC today by post.

Re: Doctor in the House, Monday 15th May 2017

Dear Sirs,

On behalf of the Organisation for the Understanding of Cluster Headache, [OUCH (UK)], and the British Association for the Study of Headache [BASH], we the undersigned wish to make the following representations regarding episode 1 of series 2 of 'Doctor in the House', BBC1, 9.00 pm, Monday 15th May 2017, presented by Dr Rangan Chatterjee.

The first case in this episode dealt with a sufferer of cluster headache.

Dr Chatterjee proceeded to witness an attack and carry out a cursory examination of the patient while she was curled up on the floor in pain. After a few minutes, the female patient recovered stood up and picked up her toddler daughter.

Headache neurologist members of BASH, make the following observations:

• The first crucial component to management of any headache disorder is correct diagnosis. The patient pictured is more likely to have paroxysmal hemicrania than cluster headache, based on the attack length and frequency of headache. It is not clear who made the diagnosis here and whether they were adequately qualified to do so.

• Assuming for a moment the diagnosis is correct, standard treatments for attacks is not mentioned: high flow oxygen and sumatriptan injections.

• No mention was made in the programme of the autonomic features that occur in paroxysmal hemicrania and cluster headache. Paroxysmal hemicrania and cluster headache are accompanied by at least one of a list of autonomic features. The autonomic features vary greatly between the conditions and are essential to a differential diagnosis.

• Failure to explain that diet does not affect paroxysmal hemicrania or cluster headache with the exception of alcohol.

• Failure to make clear that osteopathic/chiropractic treatment treated a musculo-skeletal problem the patient had, but paroxysmal hemicrania and cluster headache are neurological conditions involving the brain that simply are not altered by such approaches.

• The reduction in attacks may have a number of reasons, the most likely being that both paroxysmal hemicrania and cluster headache cycle; they go through bad and good periods spontaneously. The doctor seems unaware of this fact.

• The cause of paroxysmal hemicrania and cluster headache are not mentioned. Present research indicates that during an attack of either, an area of the brain, known as the posterior hypothalamus becomes active, but the exact trigger of that activity is not fully understood. Intensive research into the causation, particularly in relation to the posterior hypothalamus continues apace by leading experts in paroxysmal hemicrania and cluster headache on a worldwide basis.

• A brief search on the internet would have revealed the International Headache Society/World Health Organisation diagnostic criteria for these conditions as cited in the British Medical Journal [BMJ]

From the point of view of sufferers of cluster headache, the lack of clear information and a stream of erroneous information protrayed as 'facts' and the allusion in the final moments of the programme by Dr Chatterjee to a possible cure has engendered false hope in many sufferers. As any of the medical professionals in BASH will tell you paroxysmal hemicrania and cluster headache are incurable and lifelong conditions.

OUCH has had many enquiries from sufferers through social media, their helpline and website and on the back of this programme, one lady who is a severe sufferer was reported by a neighbour to the DWP as she is in receipt of PIP. The neighbour saw the 'cure' in the programme and reported the sufferer for fraudulently obtaining benefits. Other members have been openly accused by family and friends of 'putting it on', 'you never told us there was a cure,' etc. The cause of raising awareness of this devastating condition has now regressed to the level of understanding apparent ten years ago.

We would ask that these representations be copied to Dr Chatterjee and also to Studio Lambert, the production company, for their comment and clarification.

We await your response.

Signed: Board of Trustees of OUCH (UK)

Board of the British Association for the Study of Headache.

We will update you when a response from the BBC is received.

Trustees of OUCH (UK)