{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:15:23Z","timestamp":1775020523207,"version":"3.50.1"},"reference-count":43,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,7,21]],"date-time":"2015-07-21T00:00:00Z","timestamp":1437436800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2015,12]]},"abstract":"<jats:title>Abstract Critically Appraised Topic (CAT): Water Intake to Reduce Headache<\/jats:title><jats:sec><jats:title>Clinical Bottom Line<\/jats:title><jats:p>Water intake is a cost effective, non\u2010invasive and low\u2010risk intervention to reduce or prevent headache pain. Rationale: Chronic mild dehydration may trigger headache. Increased water intake could help. A small trial shows modest benefit; however, a larger methodologically sound randomized controlled trial is needed to confirm efficacy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Critically Appraised Paper<\/jats:title><jats:p>Spigt, M., Weerkamp, N., Troost, J., van Schayck, C. P., &amp; Knottnerus, J. A. (2012). \u2018A randomized trial on the effects of regular water intake in patients with recurrent headaches.\u2019 <jats:italic>Family practice<\/jats:italic>, <jats:italic>29<\/jats:italic>(4), 370\u20135. Doi: 10.1093\/fampra\/cmr112<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical scenario<\/jats:title><jats:p>Patients from primary care registered as \u2018headache\u2019, \u2018tension headache\u2019 and\/or \u2018migraine\u2019 for more than one year who suffer at least two episodes of moderately intense headache or more than four mildly intense episodes of headache per month with a daily fluid intake of less than 2.5 litres per day.<\/jats:p><\/jats:sec><jats:sec><jats:title>PICO (M)<\/jats:title><jats:p><jats:bold>P<\/jats:bold>atient\/Problem\u2009=\u2009Headache\u2009&gt;\u20091 year with 2 moderately intense or 4 mildly intense episodes per month<\/jats:p><jats:p><jats:bold>I<\/jats:bold>ntervention\u2009=\u20091.5 litres water per day\u2009+\u2009stress control and sleep hygiene<\/jats:p><jats:p><jats:bold>C<\/jats:bold>omparison\/Control\u2009=\u2009stress control and sleep hygiene<\/jats:p><jats:p><jats:bold>O<\/jats:bold>utcome\u2009=\u2009Reduce or eliminate headache<\/jats:p><jats:p><jats:bold>M<\/jats:bold>ethodology\u2009=\u2009Therapy RCT<\/jats:p><jats:p><jats:bold>Table 1<\/jats:bold>: Final Search Terms\n<jats:table-wrap position=\"anchor\">\n\n<jats:table frame=\"hsides\">\n<jats:col\/>\n<jats:col\/>\n<jats:col\/>\n<jats:tbody>\n<jats:tr>\n<jats:td><jats:bold>TRIP Data Base:<\/jats:bold> hits\u2009=\u2009517 used filter Extended Primary research 4 found 1 paper applicable<\/jats:td>\n<jats:td>'Water intake '[MeSH Terms] AND 'Headache '[All Fields]'<\/jats:td>\n<jats:td>Best match to PICO, (2012) RCT<\/jats:td>\n<\/jats:tr>\n<\/jats:tbody>\n<\/jats:table>\n\n<\/jats:table-wrap><\/jats:p><\/jats:sec><jats:sec><jats:title>Selection Criterion and Overall Results<\/jats:title><jats:p>102 headache patients in16 primary care clinics were randomized into control (n\u2009=\u200950) and intervention groups (n\u2009=\u200952) Inclusion criteria\u2009=\u2009two\u2009&gt;\u2009episodes of moderately intense headache or five\u2009&gt;\u2009mildly intense headaches per month and total fluid intake\u2009&gt;\u20092.5 litres per day, Follow\u2010up @ 3 months. 79% intervention and 66% of controls completed RCT. Drinking more water resulted in a statistically significant improvement of 4.5 (confidence interval: 1.3\u20137.8) points on Migraine\u2010Specific Quality of Life (MSQOL). 47% in the intervention (water) group self\u2010reported improvement (6\u2009&gt;\u2009on a 10\u2010point scale) against 25% in controls. Drinking water did not reduce headache days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Comments<\/jats:title><jats:p>The transparency from the author of this critically appraised paper enables others to use this study as a teaching tool and to learn from the shortcomings in the trial. The study was underpowered and contains methodological shortcomings. Participants were partially un\u2010blinded during the trial increasing the risk for bias. Only the subjective measures are statistically significant and attrition was significant. The intervention is low risk and of negligible cost. A methodologically sound RCT is recommended to evaluate if the intervention has beneficial effects.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.12413","type":"journal-article","created":{"date-parts":[[2015,7,21]],"date-time":"2015-07-21T11:05:18Z","timestamp":1437476718000},"page":"1212-1218","source":"Crossref","is-referenced-by-count":12,"title":["Increased water intake to reduce headache: learning from a critical appraisal"],"prefix":"10.1111","volume":"21","author":[{"given":"Amy","family":"Price","sequence":"first","affiliation":[{"name":"Department of Primary Health Care Sciences University of Oxford  Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Burls","sequence":"additional","affiliation":[{"name":"Health Service Research and Management Division School of Health Sciences City University London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,7,21]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"Price A.&Burls A.(2014)Citizens Research and Setting Priorities (CRISP) [Internet]. 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