Jones said as soon as the pageant was over, she took off the $500 extensions. "They were so tight, they were physically pulling my hair out," she said.
Jennifer Meram says she has avoided that problem by using clip-on extensions, which she finds easy to put in and take out. The 22-year-old from San Diego, who has been using hair extensions for about four years, is a true believer.
"I just think that every girl feels prettier with pretty hair," she said. "If I feel like if I'm having a bad hair day, I simply put on my extensions.
"To me, it makes a difference. It's like an instant confidence level."
Others see the beauty treatment as an option that discourages people from taking care of their own hair.
A'Lelia Bundles, a great-great-granddaughter of Madam C.J. Walker, who started a successful line of beauty and hair products for black women in the early 1900s, bemoans the fact that hair extensions are widely used in the black community.
"Part of the reason Madam Walker started her hair care company a hundred years ago was because women were going bald because of braiding their hair very tightly and over-processing their hair," she said. "It is as if we have not learned anything in a century."
But the allure of a full head of long hair has wide appeal. Despite her painful experience, former pageant contender Jones says, "I would probably use them again at some point, but I would try a different method this time."
As for Dr. Avitzur's patient who had the excruciating headaches, she says the woman, who had spent many hours and lots of money on the extensions, refused to believe they were the cause of her problem.
"A lot of us do crazy things for the sake of appearance," Avitzur said.