The conspiracy theory meme as a tool of cultural hegemony: A critical discourse analysis
by Rankin, James Edwin, Jr., Ph.D.
Abstract (Summary)
Those rejecting the official accounts of significant suspicious and impactful events are often labeled conspiracy theorists and the alternative explanations they propose are often referred to as conspiracy theories. These labels are often used to dismiss the beliefs of those individuals who question potentially hegemonic control of what people believe. The conspiracy theory concept functions as an impediment to legitimate discursive examination of conspiracy suspicions. The effect of the label appears to constrain even the most respected thinkers. This impediment is particularly problematic in academia, where thorough, objective analysis of information is critical to uncovering truth, and where members of the academy are typically considered among the most important of epistemic authorities. This dissertation tracked the development and use of such terms as pejoratives used to shut down critical thinking, analysis, and challenges to authority. This was accomplished using critical discourse analysis as a research methodology. Evidence suggesting government agents were instrumental in creating the pejorative meme conspiracy theorist was found in contemporary media. Tracing the evolution of the conspiracy theory meme and its use as a pejorative silencer may heighten awareness of its use in this manner and diminish its impact.
The term “conspiracy theory” was invented and put into public discourse by the CIA in 1964 in order to discredit the many skeptics who challenged the Warren Commission’s conclusion that President John F. Kennedy was assassinated by a lone gunman named Lee Harvey Oswald, who himself was assassinated while in police custody before he could be questioned. The CIA used its friends in the media to launch a campaign to make suspicion of the Warren Commission report a target of ridicule and hostility. This campaign was “one of the most successful propaganda initiatives of all time.”
This writes political science professor Lance deHaven-Smith, in his peer-reviewed book which was published by the University of Texas Press. He reports the story of how the CIA succeeded in creating in the public mind uncritical, reflexive, automatic, (System 1) stigmatization of those who challenge official government explanations (cf. ostracism).
According to Prof. DeHaven (see lecture above) the term “conspiracy theory” was first used in a scholarly book around 1913 by Charles Beard who used the phrase “the conspiracy theory of the 14th amendment”. DeHaven argues that if a wealthy women died because she fell in the shower and her husband inherits all her money we are automatically suspicious because of the low probability (base rate) of the incidence. If a similar situation happens again and the same husband is involved we are obviously even more suspicious. However, the term “conspiracy theory” prevents rational discourse (and rational thinking). DeHaven suggests the term “state crimes against democracy”. He makes the point that if we do not have a word for a crime it is very difficult to discuss it, especially if argumentators are discredited and ostracized as “conspiracy theorists” and categorized next to flat-earth believers (viz. invalid associations are created to facilitate superficial social categorisation).
Peer reviewed references on conspiracy theories – State crimes against democracy (multiple conspiracies are “organized crime”)
Related References
Elman, J. L.. (1999). Origins of language: A conspiracy theory. The Emergence of Language
“The paper presents a very interesting account of ways to be innate. in particular, the author addresses the question of chronotopic innateness, showing that children are not necessarily equiped with a ug or similar device, but are aided in their language acquisition process by the restrictions on the perception and memory capacities.”
“Over one-quarter of all federal criminal prosecutions and a large number of state cases involve prosecutions for conspiracy. yet, the major scholarly articles and the bulk of prominent jurists have roundly condemned the doctrine. this article offers a functional justification for the legal prohibition against conspiracy, centering on psychological and economic accounts. advances in psychology over the past thirty years have demonstrated that groups cultivate a special social identity. this identity often encourages risky behavior, leads individuals to behave against their self-interest, solidifies loyalty, and facilitates harm against non-members. so, too, economists have developed sophisticated explanations for why firms promote efficiency, leading to new theories in corporate law. these insights can be ‘reverse-engineered’ to make conspiracies operate less efficiently. in reverse-engineering corporate-law principles and introducing lessons from psychology, a rich account of how government should approach conspiracy begins to unfold. in particular, law enforcement strives to prevent conspiracies from forming by imposing high up-front penalties for joiners but uses mechanisms to harvest information from those who have joined and decide to cooperate with the government. traditional conspiracy doctrines such as pinkerton liability and the exclusion from merger not only further cooperation agreements, they also make conspiracies more difficult to create and maintain by forcing them to adopt bundles of inefficient practices. the possibility of defection forces the syndicate to use expensive monitoring of its employees for evidence of possible collusion with the government. mechanisms for defection also break down trust within the group and prime members to think that others are acting out of self-interest. the article concludes by offering a variety of refinements to conspiracy law that will help destabilize trust within the conspiracy, cue the defection of conspirators, and permit law enforcement to extract more information from them.”
Miller, J. M., Saunders, K. L., & Farhart, C. E.. (2016). Conspiracy Endorsement as Motivated Reasoning: The Moderating Roles of Political Knowledge and Trust. American Journal of Political Science
“Given the potential political and social significance of conspiracy beliefs, a substantial and growing body of work examines the individual-level correlates of belief in conspiracy theories and general conspiratorial predispositions. however, although we know much about the psychological antecedents of conspiracy endorsement, we know less about the individual-level political causes of these prevalent and consequential beliefs. our work draws from the extant literature to posit that endorsement of conspiracy theories is a motivated process that serves both ideological and psychological needs. in doing so,we develop a theory that identifies a particular type of person—onewho is both highly knowledgeable about politics and lacking in trust—who ismost susceptible to ideologicallymotivated conspiracy endorsement. further, we demonstrate that the moderators of belief in conspiracy theories are strikingly different for conservatives and liberals.”
Swami, V., Coles, R., Stieger, S., Pietschnig, J., Furnham, A., Rehim, S., & Voracek, M.. (2011). Conspiracist ideation in Britain and Austria: Evidence of a monological belief system and associations between individual psychological differences and real-world and fictitious conspiracy theories. British Journal of Psychology
“Despite evidence of widespread belief in conspiracy theories, there remains a dearth of research on the individual difference correlates of conspiracist ideation. in two studies, we sought to overcome this limitation by examining correlations between conspiracist ideation and a range of individual psychological factors. in study 1, 817 britons indicated their agreement with conspiracist ideation concerning the july 7, 2005 (7/7), london bombings, and completed a battery of individual difference scales. results showed that stronger belief in 7/7 conspiracy theories was predicted by stronger belief in other real-world conspiracy theories, greater exposure to conspiracist ideation, higher political cynicism, greater support for democratic principles, more negative attitudes to authority, lower self-esteem, and lower agreeableness. in study 2, 281 austrians indicated their agreement with an entirely fictitious conspiracy theory and completed a battery of individual difference measures not examined in study 1. results showed that belief in the entirely fictitious conspiracy theory was significantly associated with stronger belief in other real-world conspiracy theories, stronger paranormal beliefs, and lower crystallized intelligence. these results are discussed in terms of the potential of identifying individual difference constellations among conspiracy theorists.”
Darwin, H., Neave, N., & Holmes, J.. (2011). Belief in conspiracy theories. The role of paranormal belief, paranoid ideation and schizotypy. Personality and Individual Differences
“Two studies examined correlates of belief in a jewish conspiracy theory among malays in malaysia, a culture in which state-directed conspiracism as a means of dealing with perceived external and internal threats is widespread. in study 1, 368 participants from kuala lumpur, malaysia, completed a novel measure of belief in a jewish conspiracy theory, along with measures of general conspiracist ideation, and anomie. initial analysis showed that the novel scale factorially reduced to a single dimension. further analysis showed that belief in the jewish conspiracy theory was only significantly associated with general conspiracist ideation, but the strength of the association was weak. in study 2, 314 participants completed the measure of belief in the jewish conspiracy theory, along with measures of general conspiracist ideation, and ideological attitudes. results showed that belief in the jewish conspiracy theory was associated with anti-israeli attitudes, modern racism directed at the chinese, right-wing authoritarianism, and social dominance orientation. general conspiracist ideation did not emerge as a significant predictor once other variables had been accounted for. these results suggest that there may be specific cultural and social psychological forces that drive belief in the jewish conspiracy theory within the malaysian context. specifically, belief in the jewish conspiracy theory among malaysian malays appears to serve ideological needs and as a mask for anti-chinese sentiment, which may in turn reaffirm their perceived ability to shape socio-political processes.”
Wood, M. J., & Douglas, K. M.. (2013). What about building 7?” A social psychological study of online discussion of 9/11 conspiracy theories. Frontiers in Psychology
“Recent research into the psychology of conspiracy belief has highlighted the importance of belief systems in the acceptance or rejection of conspiracy theories. we examined a large sample of conspiracist (pro-conspiracy-theory) and conventionalist (anti-conspiracy-theory) comments on news websites in order to investigate the relative importance of promoting alternative explanations vs. rejecting conventional explanations for events. in accordance with our hypotheses, we found that conspiracist commenters were more likely to argue against the opposing interpretation and less likely to argue in favor of their own interpretation, while the opposite was true of conventionalist commenters. however, conspiracist comments were more likely to explicitly put forward an account than conventionalist comments were. in addition, conspiracists were more likely to express mistrust and made more positive and fewer negative references to other conspiracy theories. the data also indicate that conspiracists were largely unwilling to apply the ‘conspiracy theory’ label to their own beliefs and objected when others did so, lending support to the long-held suggestion that conspiracy belief carries a social stigma. finally, conventionalist arguments tended to have a more hostile tone. these tendencies in persuasive communication can be understood as a reflection of an underlying conspiracist worldview in which the details of individual conspiracy theories are less important than a generalized rejection of official explanations.”
Newheiser, A. K., Farias, M., & Tausch, N.. (2011). The functional nature of conspiracy beliefs: Examining the underpinnings of belief in the Da Vinci Code conspiracy. Personality and Individual Differences
Dagnall, N., Drinkwater, K., Parker, A., Denovan, A., & Parton, M.. (2015). Conspiracy theory and cognitive style: A worldview. Frontiers in Psychology
“This paper assessed whether belief in conspiracy theories was associated with a particularly cognitive style (worldview). the sample comprised 223 volunteers recruited via convenience sampling and included undergraduates, postgraduates, university employees, and alumni. respondents completed measures assessing a range of cognitive-perceptual factors (schizotypy, delusional ideation, and hallucination proneness) and conspiratorial beliefs (general attitudes toward conspiracist thinking and endorsement of individual conspiracies). positive symptoms of schizotypy, particularly the cognitive-perceptual factor, correlated positively with conspiracist beliefs. the best predictor of belief in conspiracies was delusional ideation. consistent with the notion of a coherent conspiratorial mindset, scores across conspiracy measures correlated strongly. whilst findings supported the view that belief in conspiracies, within the sub-clinical population, was associated with a delusional thinking style, cognitive-perceptual factors in combination accounted for only 32% of the variance.”
Xu, Z., Pothula, S. P., Wilson, J. S., & Apte, M. V.. (2014). Pancreatic cancer and its stroma: A conspiracy theory. World Journal of Gastroenterology
“Pancreatic cancer is characterised by a prominent desmoplastic/stromal reaction that has received little attention until recent times. given that treatments focusing on pancreatic cancer cells alone have failed to significantly improve patient outcome over many decades, research efforts have now moved to understanding the pathophysiology of the stromal reaction and its role in cancer progression. in this regard, our group was the first to identify the cells (pancreatic stellate cells, pscs) that produced the collagenous stroma of pancreatic cancer and to demonstrate that these cells interacted closely with cancer cells to facilitate local tumour growth and distant metastasis. evidence is accumulating to indicate that stromal pscs may also mediate angiogenesis, immune evasion and the well known resistance of pancreatic cancer to chemotherapy and radiotherapy. this review will summarise current knowledge regarding the critical role of pancreatic stellate cells and the stroma in pancreatic cancer biology and the therapeutic approaches being developed to target the stroma in a bid to improve the outcome of this devastating disease.”
Geertz, C.. (1973). Thick Description: Toward an Interpretative Theory of Culture. In The Interpretation of Cultures
“From: anthropology.ua.edu/cultures/cultures.php?culture=symbolic%20and%20interpretive%20anthropologies thick description is a term geertz borrowed from gilbert ryle to describe and define the aim of interpretive anthropology. he argues that social anthropology is based on ethnography, or the study of culture. culture is based on the symbols that guide community behavior. symbols obtain meaning from the role which they play in the patterned behavior of social life. culture and behavior cannot be studied separately because they are intertwined. by analyzing the whole of culture as well as its constituent parts, one develops a ‘thick description’ which details the mental processes and reasoning of the natives thick description, however, is an interpretation of what the natives are thinking made by an outsider who cannot think like a nativebut is made possible by anthropological theory (geertz 1973d; see also tongs 1993). to illustrate thick description, geertz uses ryle’s example which discusses the difference between a ‘blink’ and a ‘wink.’ one, a blink, is an involuntary twitch –the thin description– and the other, a wink, is a conspiratorial signal to a friend–the thick description. while the physical movements involved in each are identical, each has a distinct meaning ‘as anyone unfortunate enough to have had the first taken for the second knows’ (geertz 1973d:6). a wink is a special form of communication which consists of several characteristics: it is deliberate; to someone in particular; to impart a particular message; according to a socially established code; and without the knowledge of the other members of the group of which the winker and winkee are a part. in addition, the wink can be a parody of someone else’s wink or an attempt to lead others to believe that a conspiracy of sorts is occuring. each type of wink can be considered to be a separate cultural category (geertz 1973d:6-7). the combination of the blink and the types of winks discussed above (and those that lie between them) produce ‘a stratified hierarchy of meaningful structures’ (geertz 1973d:7) in which winks and twitches are produced and interpreted. this, geertz argues, is the object of ethnography: to decipher this hierarchy of cultural categories. the thick description, therefore, is a description of the particular form of communication used, like a parody of someone else’s wink or a conspiratorial wink.”
Van der Linden, S.. (2015). The conspiracy-effect: Exposure to conspiracy theories (about global warming) decreases pro-social behavior and science acceptance. Personality and Individual Differences
“Although public endorsement of conspiracy theories is growing, the potentially negative societal consequences of widespread conspiracy ideation remain unclear. while past studies have mainly examined the personality correlates of conspiracy ideation, this study examines the conspiracy-effect; the extent to which exposure to an actual conspiracy theory influences pro-social and environmental decision-making. participants (n=316) were randomly assigned to one of three conditions; (a) a brief conspiracy video about global warming, (b) an inspirational pro-climate video or (c) a control group. results indicate that those participants who were exposed to the conspiracy video were significantly less likely to think that there is widespread scientific agreement on human-caused climate change, less likely to sign a petition to help reduce global warming and less likely to donate or volunteer for a charity in the next six months. these results strongly point to the socio-cognitive potency of conspiracies and highlight that exposure to popular conspiracy theories can have negative and undesirable societal consequences.”
Wood, M. J.. (2016). Some Dare Call It Conspiracy: Labeling Something a Conspiracy Theory Does Not Reduce Belief in It. Political Psychology
“‘Conspiracy theory’ is widely acknowledged to be a loaded term. politicians use it to mock and dismiss allegations against them, while philosophers and political scientists warn that it could be used as a rhetorical weapon to pathologize dissent. in two empirical studies conducted on amazon mechanical turk, i present an initial examination of whether this concern is justified. in experiment 1, 150 participants judged a list of historical and speculative theories to be no less likely when they were labeled ‘conspiracy theories’ than when they were labeled ‘ideas.’ in experiment 2 (n5802), participants who read a news article about fictitious ‘corruption allegations’ endorsed those allegations no more than participants who saw them labeled ‘conspiracy theories.’ the lack of an effect of the conspiracy-theory label in both experiments was unexpected and may be due to a romanticized image of conspiracy theories in popular media or a dilution of the term to include mundane speculation regarding corruption and political intrigue.”
Pratt, R.. (2003). Theorizing conspiracy. Theory and Society
“Anders behring breivik, perpetrator of the norwegian massacre, was motivated by a belief in a muslim conspiracy to take over europe. extreme and aberrant his actions were, but, explains the author, elements of this conspiracy theory are held and circulated in europe today across a broad political spectrum, with internet-focused counter-jihadist activists at one end and neoconservative and cultural conservative columnists, commentators and politicians at the other. the political fallout from the circulation of these ideas ranges from test cases over free speech in the courts to agitation on the ground from defence leagues, anti-minaret campaigners and stop islamisation groups. although the conspiracy draws on older forms of racism, it also incorporates new frameworks: the clash of civilisations, islamofascism, the new anti-semitism and eurabia. this muslim conspiracy bears many of the hallmarks of the ‘jewish conspiracy theory’, yet, ironically, its adherents, some of whom were formerly linked to anti-semitic traditions, have now, because of their fear of islam and arab countries, become staunch defenders of israel and zionism. reprinted by permission of the institute of race relations”
Raab, M. H., Ortlieb, S. A., Auer, N., Guthmann, K., & Carbon, C. C.. (2013). Thirty shades of truth: Conspiracy theories as stories of individuation, not of pathological delusion. Frontiers in Psychology
“Recent studies on conspiracy theories employ standardized questionnaires, thus neglecting their narrative qualities by reducing them to mere statements. recipients are considered as consumers only. two empirical studies-a conventional survey (n = 63) and a study using the method of narrative construction (n = 30)-which were recently conducted by the authors of this paper-suggest that the truth about conspiracy theories is more complex. given a set of statements about a dramatic historic event (in our case 9/11) that includes official testimonies, allegations to a conspiracy and extremely conspiratorial statements, the majority of participants created a narrative of 9/11 they deemed plausible that might be considered a conspiracy theory. the resulting 30 idiosyncratic stories imply that no clear distinction between official story and conspiratorial narrative is possible any more when the common approach of questionnaires is abandoned. based on these findings, we present a new theoretical and methodological approach which acknowledges conspiracy theories as a means of constructing and communicating a set of personal values. while broadening the view upon such theories, we stay compatible with other approaches that have focused on extreme theory types. in our view, accepting conspiracy theories as a common, regulative and possibly benign phenomenon, we will be better able to understand why some people cling to immunized, racist and off-wall stories-and others do not.”
Brotherton, R., French, C. C., & Pickering, A. D.. (2013). Measuring belief in conspiracy theories: The generic conspiracist beliefs scale. Frontiers in Psychology
“The psychology of conspiracy theory beliefs is not yet well understood, although research indicates that there are stable individual differences in conspiracist ideation – individuals’ general tendency to engage with conspiracy theories. researchers have created several short self-report measures of conspiracist ideation. these measures largely consist of items referring to an assortment of prominent conspiracy theories regarding specific real-world events. however, these instruments have not been psychometrically validated, and this assessment approach suffers from practical and theoretical limitations. therefore, we present the generic conspiracist beliefs (gcb) scale: a novel measure of individual differences in generic conspiracist ideation. the scale was developed and validated across four studies. in study 1, exploratory factor analysis of a novel 75-item measure of non-event-based conspiracist beliefs identified five conspiracist facets. the 15-item gcb scale was developed to sample from each of these themes. studies 2, 3, and 4 examined the structure and validity of the gcb, demonstrating internal reliability, content, criterion-related, convergent and discriminant validity, and good test-retest reliability. in sum, this research indicates that the gcb is a psychometrically sound and practically useful measure of conspiracist ideation, and the findings add to our theoretical understanding of conspiracist ideation as a monological belief system unpinned by a relatively small number of generic assumptions about the typicality of conspiratorial activity in the world.”
Butt, L.. (2005). “Lipstick Girls” and “Fallen Women”: AIDS and Conspiratorial Thinking in Papua, Indonesia. Cultural Anthropology
“A widespread theory in the province of papua, eastern indonesia, links the spread of sex workers and hiv/aids to a broader government conspiracy to eliminate indigenous papuans. explicit conspiratorial thinking by indigenous papuans draws from diverse evidence such as provincial partition legislation, patterns of sex-industry usage, economic transformations, rumors of witchcraft, and new automobile technology. this article argues against treating conspiracy theories about aids simply as symbolically powerful rumors expressing indigenous papuans’ perceptions of oppression and unequal access to state resources. rather, conspiracy theories articulate awareness of inconsistencies in the government’s formulation and administration of sexual regulations and aids-prevention policies. aids conspiracy theories can therefore be understood as pragmatic and detailed interpretations of papuan lived experiences in a context of ethnically disenfranchising forms of power in post-suharto indonesia.”
Briones, R., Nan, X., Madden, K., & Waks, L.. (2012). When Vaccines Go Viral: An Analysis of HPV Vaccine Coverage on YouTube. Health Communication
“This article reports a content analysis of youtube videos related to the human papillomavirus (hpv) vaccine. in total, 172 youtube videos were examined with respect to video sources, tones, and viewer responses. additionally, coverage of specific content was analyzed through the lens of the health belief model (rosenstock, 1974) and in terms of two content themes (i.e., conspiracy theory and civil liberties). the relations among these aspects of the videos were assessed as well. we found that most of these videos were news clips or consumer-generated content. the majority of the videos were negative in tone, disapproving of the hpv vaccine. in addition, negative videos were liked more by the viewers than positive or ambiguous ones. accusations of conspiracy theory and infringement of civil liberties were manifested in these videos. the videos also presented mixed information related to the key determinants of health behavior as stipulated in the health belief model. implications for the findings are discussed.”
Phillipson, R.. (2007). Linguistic imperialism: a conspiracy, or a conspiracy of silence?. Language Policy
“This is a response to bernard spolsky’s coverage of ‘how english spread’ in his book on language policy (2004) and his assertion that my book on linguistic imperialism (1992) subscribes to a conspiracy theory.”
Stojanov, A.. (2015). Reducing conspiracy theory beliefs. Psihologija
“This study aimed to look at possible ways to reduce beliefs in conspiracy theories and increase the intention to have a fictitious child vaccinated. one hundred and sixty participants answered an online questionnaire. three groups were used. the control group did not read any text prior to answering whereas the two experimental groups read either only debunking information or information about the motives of the conspiracists and the fallacy in their reasoning in addition to the debunking paragraph. the second experimental manipulation was effective in reducing medical conspiracy theories beliefs, but not belief in conspiracy theories in general. neither intervention was effective in increasing the likelihood to have a fictitious child vaccinated. those not intending to vaccinate a fictitious child endorsed conspiracy theories to a greater degree. a positive correlation between beliefs in conspiracy theories and the experiential/intuitive information processing system was found.”
Stempel, C., Hargrove, T., & Stempel, G. H.. (2007). Media use, social structure, and belief in 9/11 conspiracy theories. Journalism and Mass Communication Quarterly
“A survey of 1,010 randomly selected adults asked about media use and belief in three conspiracy theories about the attacks of september 11, 2001. ‘paranoid style’ and ‘cultural sociology’ theories are outlined, and empirical support is found for both. patterns vary somewhat by conspiracy theory, but members of less powerful groups (racial minorities, lower social class, women, younger ages) are more likely to believe at least one of the conspiracies, as are those with low levels of media involvement and consumers of less legitimate media (blogs and grocery store tabloids). consumers of legitimate media (daily newspapers and network tv news) are less likely to believe at least one of the conspiracies, although these relationships are not significant after controlling for social structural variables. beliefs in all three conspiracies are aligned with mainstream political party divisions, evidence that conspiracy thinking is now a normal part of mainstream political conflict in the united states. publication abstract]”
Craft, S., Ashley, S., & Maksl, A.. (2017). News media literacy and conspiracy theory endorsement. Communication and the Public
“Conspiracy theories flourish in the wide-open media of the digital age, spurring concerns about the role of misinformation in influencing public opinion and election outcomes. this study examines whether news media literacy predicts the likelihood of endorsing conspiracy theories and also considers the impact of literacy on partisanship. a survey of 397 adults found that greater knowledge about the news media predicted a lower likelihood of conspiracy theory endorsement, even for conspiracy theories that aligned with their political ideology.”
Gardener, T., & Moffat, J.. (2008). Changing behaviours in defence acquisition: A game theory approach. Journal of the Operational Research Society
“Why do so many major defence contracts fail to deliver to the contractually agreed performance, time and cost requirements? this paper identifies the conspiracy of optimism as an important factor in the initiation of many projects. using a combination of game theory and participatory workshops, we formulate a theory on the conspiracy of optimism and test it experimentally. this work forms part of a culture and behaviour change initiative within defence acquisition involving the ministry of defence and many defence contractors. [publication abstract]”
Sharp, D.. (2008). Advances in conspiracy theory. The Lancet
“CONTEXT: headache is a common, disabling disorder that is frequently not well managed in general clinical practice. objective: to determine if patients cared for in a coordinated headache management program would achieve reduced headache disability compared with patients in usual care. design: a randomized controlled trial of headache management vs usual care. setting: three distinctly different practice sites: an academic internal medicine practice located in a major east coast city, a staff-model managed care organization located in a major west coast city, and a community practice in a medium-sized city in the southeast. patients.- individuals 21 years of age or older with chronic tension-type, migraine, or mixed etiology headache and a migraine disability assessment (midas) score greater than 5, not receiving treatment from a neurologist or headache clinic currently or within the previous 6 months and with an intention to continue general medical care at their current location and to continue their present health insurance coverage for the next 12 months. interventions: active intervention is a headache management program consisting of: (1) a class specifically designed to inform patients about headache types, triggers, and treatment options; (2) diagnosis and treatment by a professional especially trained in headache care (based on us headache consortium guidelines); and (3) proactive follow-up by a case manager. participation lasted 6 months. control patients received usual care from their primary care providers. main outcome measures: the primary efficacy measure reported in this article is a comparison of midas scores of headache disability between the intervention group and the control group at 6 months. secondary measures were response at 12 months, general health and quality of life, and satisfaction with headache care. results: the intervention improved (ie, decreased) midas scores by 7.0 points (95% confidence interval 2.9 to 11.1) more than the control (p = .008) at 6 months. the difference was not affected by site (p = .59 for clinic by intervention interaction), and a trend toward persistent benefit at 12 months (mean difference in improvement 6.8 points, 95% confidence interval -.3 to 13.9, p = .06) was observed. quality of life and satisfaction with headache treatment were similarly improved. conclusions: coordinated headache management significantly improved outcomes for patients who, despite contact with the healthcare system for hea…”