Placebo vs Nocebo Effect on Migraine Treatment

Placebo vs Nocebo Effect on Migraine Treatment

Category Placebo Effect Nocebo Effect
Definition 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
Enhancing Factors 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.
Psychological Basis Expectation of benefit, motivation, and reward circuits. Expectation of harm, fear, and avoidance circuits.
Physiological Basis Activation of descending pain pathways and dopamine reward circuits in the brain. Increased activity in brain regions processing fear, anxiety and pain sensations.
Clinical Importance Maximizing placebo can improve patient outcomes and treatment effectiveness. Minimizing nocebo can improve patient outcomes and treatment compliance.
Modifiability Can be enhanced through empathy, reassurance, positive framing by healthcare providers. Can be minimized through empathy, reassurance about side effects, careful adverse event reporting.
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