Placebo and nocebo in the treatment of migraine: How much does real world effectiveness depend on contextual effects?

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  • Hauke Basedau
  • Raffaele Ornello
  • Eleonora De Matteis
  • Bolortsetseg Davaasuren
  • Begimai Kadyrova
  • Doga Vuralli
  • Myroslav Bozhenko
  • Ilaha Azizova
  • Natia Bitsadze
  • Elnura Eralieva
  • dlt446, dlt446
  • Dimos Mitsikostas
  • Francesca Puledda

Purpose: Treatments in medicine impact individuals beyond their intended effects, due to phenomena such as the placebo and nocebo effects. The placebo effect arises from the positive expectation of a treatment being beneficial, while the nocebo effect stems from the negative expectation of a treatment causing harm. Both in real-world practice and clinical trials, treatments can lead to outcomes unrelated to their intended mechanism of action, which we categorize as placebo and nocebo responses. These responses, combined with the inherent fluctuation in a condition's natural progression, regression to the mean, and random comorbidities, make up a significant part of the therapeutic experience. Particularly in pain management, placebo and nocebo effects play a substantial role. By addressing modifiable contextual factors such as patient expectations, lifestyle choices, and the therapeutic relationship, healthcare providers can enhance the effectiveness of migraine treatments, paving the way for a more comprehensive, individualized approach to patient care. We must also consider non-modifiable factors like personal experiences, beliefs, and information from social media and the internet. Conclusion: This review offers a summary of our current understanding of the placebo and nocebo effects in migraine management.

Original languageEnglish
JournalCephalalgia
Volume43
Issue number12
Pages (from-to)1-12
ISSN0333-1024
DOIs
Publication statusPublished - 2023

Bibliographical note

Publisher Copyright:
© International Headache Society 2023.

    Research areas

  • contextual effects, headache, Migraine, nocebo, placebo

ID: 389904867