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Power of Suggestion Shown in Study of Migraine Drug

Expectation plays important role in response to treatment, expert says

WebMD News from HealthDay

High cure rates, few side effects may make this

By Mary Brophy Marcus

HealthDay Reporter

WEDNESDAY, Jan. 8, 2014 (HealthDay News) -- A new study of migraine sufferers suggests that what you're told when your doctor prescribes medication can influence your body's response to it.

Researchers from Harvard Medical School and Beth Israel Deaconess Medical Center in Boston compared the effects of a common migraine drug and an inactive placebo in 66 people who suffer from migraines. The condition includes throbbing headache, nausea, vomiting and sensitivity to light and sound.

The results consistently showed that taking the pills accompanied by positive information increased the effectiveness of the treatment, whether the patient had taken the real deal -- the drug Maxalt -- or a pill labeled "placebo."

Headache specialist Dr. Andrew Charles said the study demonstrates that expectation about response plays an important role in the ultimate response to a treatment.

"When migraine patients were told by their doctor that a pill would help ease their headaches, this advice seemed to produce results whether or not the pill was a real migraine medication or a dummy placebo," said Charles, professor and director of the headache research and treatment program in the department of neurology at University of California School of Medicine, Los Angeles.

"Relief was still higher with the actual medicine, so drugs do work beyond the placebo effect, but the researchers say that the placebo effect may still account for half of the therapeutic value of a drug," said Charles, who was not involved in the research.

For the study, published online Jan. 8 in the journal Science Translational Medicine, the scientists studied more than 450 migraine attacks in the study participants, following them over seven separate episodes.

To establish a baseline, each person was asked to report their pain and symptoms 30 minutes after the onset of an unmedicated migraine episode, and again 2.5 hours after its onset.

Each participant then received six treatment envelopes. The envelopes were labeled in one of three ways: "Maxalt" (rizatriptan); "placebo"; or "Maxalt or placebo." The labels were true for four attacks and false for two attacks.

The three situations were labeled by the researchers as positive (meaning a drug that could help with migraine symptoms was provided), negative (meaning no drug, only a placebo pill was provided), or neutral (meaning it was unknown if the drug or placebo pill was within the envelope). But for two situations, one of the "Maxalt" envelopes actually held a placebo and one of the "placebo" envelopes contained Maxalt.

The participants were asked to self-report their responses to treatment over the course of their next six migraine episodes.

Dr. Ted Kaptchuk, a senior author of the study, said that even though Maxalt was superior to the placebo in terms of alleviating pain, "we found that under each of the three messages, the placebo effect accounted for at least 50 percent of the subjects' overall pain relief."

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