Substantial recovery rate with placebo effect in headache treatment

Headache is a very common complaint, with over 90% of all persons experiencing a headache at some time in their lives. Headaches commonly are tension-type (TTH) or migraine. They have high socioeconomic impact and can disturb most daily activities. Treatments range from pharmacologic to behavioral interventions. In a study published online today in the Journal of Manipulative and Physiological Therapeutics, a group of Dutch researchers analyzed 119 randomized controlled clinical trials (RCTs) and determined the magnitude of placebo effect and no treatment effect on headache recovery rate.

"Although the intention of control and placebo interventions in research studies is to be relatively ineffective, the question rises as to what factors might cause improvement seen in these groups," commented corresponding investigator Arianne P. Verhagen, PhD, Assistant Professor, Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands. "The aim of this study was to analyze the observed effects in the 'no treatment' and placebo control groups in with TTH and migraine patients."

In the headache clinical trials studied, the "no treatment" and placebo groups had a high overall recovery rate of 36%. Control groups in pharmacological trials showed a higher response rate than the behavioral (non-pharmacological) trials (38.5% vs. 15.0%). Patients had higher recovery rates in the acute treatments compared with the prophylactic treatments (39.6% vs. 32.8%). Knowing that a substantial portion of patients improve without treatment is important when considering the benefits and risks of daily headache treatment.

Pharmacological treatment typically starts when non-pharmacological treatments like , relaxation therapy, cognitive therapy, and reassurance do not work. Many of the prescribed or over-the-counter medications, such as (NSAIDs), may lead to adverse events and medication overuse headache. Considering the risks of adverse events, the authors recommend that "the prescription of medication needs to be carefully considered and evaluated with each individual patient. Because of the recovery results in 'no treatment' control groups in pharmacological trials, the question rises whether or not this way of prescription is always preferable over no treatment (wait and see) especially in the TTH population."

More information: The article is "Headache: The Placebo Effects in the Control Groups in Randomized Clinical Trials; An Analysis of Systematic Reviews" by Femke M. de Groot, BSc, Annieke Voogt-Bode, BSc, Jan Passchier, PhD, Marjolein Y. Berger, MD, Bart W. Koes, PhD, and Arianne P. Verhagen, PhD. It will appear in the Journal of Manipulative and Physiological Therapeutics, Volume 34, Issue 5 (June 2011), DOI 10.1016/j.jmpt.2011.04.007

add to favorites email to friend print save as pdf

Related Stories

A primer on migraine headaches

Feb 16, 2010

Migraine headache affects many people and a number of different preventative strategies should be considered, states an article in CMAJ (Canadian Medical Association Journal). The article, a primer for physicians, outlin ...

Study shows that exercise reduces migraine suffering

Mar 26, 2009

While physical exercise has been shown to trigger migraine headaches among sufferers, a new study describes an exercise program that is well tolerated by patients. The findings show that the program decreased the frequency ...

Fewer headaches on the horizon thanks to latest guidelines

Jan 06, 2010

If you're one of the millions of headache sufferers around the world, more effective relief might be on the way in years to come. That's because the International Headache Society has just published new research guidelines ...

Recommended for you

Obama addresses West Africans on facts about Ebola

2 hours ago

President Barack Obama urged West Africans on Tuesday to wear gloves and masks when caring for Ebola patients or burying anyone who died of the disease. He also discouraged the traditional burial practice ...

Gluten-free diet benefits asymptomatic EmA+ adults

2 hours ago

(HealthDay)—Asymptomatic individuals with endomysial antibodies (EmA) benefit from a gluten-free diet (GFD), according to a study published in the September issue of Gastroenterology.

Another US health worker infected with Ebola

3 hours ago

A third American health worker has tested positive for the Ebola virus while working with patients in West Africa, the Christian missionary group SIM said Tuesday.

UN implores all countries to help on Ebola

5 hours ago

The international group Doctor Without Borders warned Tuesday that the world is 'losing the battle' against Ebola, while U.N. officials implored all countries to quickly step up their response by contributing health experts ...

Travel restrictions could worsen Ebola crisis: experts

9 hours ago

Travel restrictions could worsen West Africa's Ebola epidemic, limiting medical and food supplies and keeping out much-needed doctors, virologists said Tuesday as the disease continued its deadly spread.

User comments