|An inactive treatment that leads to improvement in migraine due to positive patient expectations.
|A treatment (inactive or active) that leads to worsening of migraine or the presence of adverse effects due to negative patient expectations.
|Incidence in clinical trials
|Up to 32.4% for acute treatments
Up to 30.4% for preventives
|Up to 18.4% for acute treatments
Up to 47% for preventives
|Positive doctor-patient relationship, parenteral route (especially surgery), specific drug mechanisms, branding/marketing, prior positive experiences.
|Psychiatric comorbidities, chronic migraine, prior treatment failures, generic medications, observation of side effects in others.
|Expectation of benefit, motivation, and reward circuits.
|Expectation of harm, fear, and avoidance circuits.
|Activation of descending pain pathways and dopamine reward circuits in the brain.
|Increased activity in brain regions processing fear, anxiety and pain sensations.
|Maximizing placebo can improve patient outcomes and treatment effectiveness.
|Minimizing nocebo can improve patient outcomes and treatment compliance.
|Can be enhanced through empathy, reassurance, positive framing by healthcare providers.
|Can be minimized through empathy, reassurance about side effects, careful adverse event reporting.