Placebo vs Nocebo Effect on Migraine Treatment
Posted on December 09 2023,
Stay in the Loop on the Latest in Migraine:
| 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. |
Wed, Jan 14, 26
New Emergency Department Migraine Treatment Guidelines
The American Headache Society (AHS) has released its 2025 guideline update for the acute treatment of migraine in adults presenting to the emergency department. This update, published in Headache in...
Read MoreSun, Jan 04, 26
Long-Term Safety of Anti-CGRP Monoclonal Antibodies
A comprehensive meta-analysis of over 4,300 patients reveals that erenumab, galcanezumab, fremanezumab, and eptinezumab maintain good tolerability beyond 12 months. Only 3% of patients stopped treatment due to adverse events,...
Read MoreThu, Jan 01, 26
Alternate Nostril Breathing Protocol for Migraine
Alternate nostril breathing is a simple yogic technique that's showing real promise for migraine prevention. Unlike acute treatments, this practice builds nervous system resilience over time - making attacks less...
Read More