Placebo, Nocebo, and Migraines
The placebo effect in migraine treatment is a medical phenomenon.
The nocebo effect is also well documented. A nocebo is basically the opposite of a placebo: a detrimental health outcome from negative expectations.
This article discusses how your thoughts can improve or worsen migraine treatments.
Eight Ways Placebos Help Migraineurs
1. Injection Placebo
Injection placebos have higher success rates than pill placebos.
Botox cuts the number of migraine attacks per month in half for 54 percent of episodic migraineurs (those with under 15 migraine days per month). Placebo injections of Botox are slightly more effective than the actual drug for episodic migraine (study).
Botox’s high placebo rate is why it’s only approved for chronic migraines (15 plus migraine days per month) and not episodic migraines (under 15 days per month).
One osteoarthritis study found that placebo injections are more effective than sugar pills and 1.6 times more effective than actual medication. Fake topical cream also worked better than a sugar pill (study).
2. Pill Placebos in Children
Fifty-three to 58 percent of children and adolescents that take triptan placebos (sugar pills) experience migraine relief.
The actual triptan drugs have far lower success rates in children and come with side effects (study 1, 2). Amitriptyline and topiramate are also less effective than the placebo in children migraineurs (study).
The placebo effect in children may be more powerful than in adults because children are more likely to believe in fiction.
3. Pill Placebos in Adults
An assessment of 12 years of triptan trials found that the placebo response for pain relief ranged from 17 percent to 50 percent of adult migraineurs (study).
About 42 to 60 percent of migraineurs respond to actual triptans pills (study). Placebos for triptans are roughly half as effective as the actual drug.
The success of triptans is often temporary as they can lose strength over time or lead to more frequent migraines.
4. Positivity Placebo
Amitriptyline is an anti-depressant and a top migraine treatment.
A large study found that 50 percent of migraine patients taking amitriptyline cut their migraine frequency in half. However, there was no significant difference between the placebo and the actual drug (study).
Research shows that placebos for mild or moderate depression have the same effects as antidepressants (study).
It seems that the placebo for drugs intended to increase positivity have a profound effect on migraine outcome.
5. Acupuncture Placebo
A study of 480 migraineurs found that migraine days per month dropped by 60 percent in those who received acupuncture. The patients given sham acupuncture also had a 40 percent drop in migraine days by the end of the 16-week study (study).
A sham acupuncture is administering needles is places with no known medical benefit. Sham acupuncture is considered a placebo, but it’s unclear if it has a true medical benefit or not.
6. Expensive Placebos
Sixty-seven percent of patients who were told that they had received the next-generation migraine drug, which cost between $8,000 and $20,000 dollars per year, reduced their migraine frequency by more than 50 percent. Seventeen percent of the placebo group had complete migraine remission (Medscape).
“Expensive placebos are more effective than cheap ones,” according to research published in the journal JAMA (study).
The appeal of a new or expensive drug increases the placebo effect against migraines.
7. Placebos Do What You Believe They Will
Placebo effects are consistent with the drug they are compared to.
For example, the placebo for aspirin is about 55 percent as effective as real aspirin. The placebo for morphine is roughly 55 percent as effective as real morphine (study).
Fun Fact: 1000 mg of aspirin is just as effective as 100 mg of sumatriptan (13 studies). Morphine is also used to treat migraines in emergency rooms, although it is not recommended.
Sham surgery for osteoporosis is just as effective as the real surgery (study). Sham surgery involves incisions and stiches, but no actual cartilage or inflammation is removed. Amazingly, patients improve in rehab as well as patients given the real surgery.
8. Unpleasant Placebos are the Best Placebos
Big pills, stinky pills, multiple pills per day, painful injections, or sham surgery will increase the effectiveness of a placebo (study).
The nasal spray placebo for Sumatriptan is almost twice as effective as the placebo pill for Sumatriptan (study). The placebo injection for the next-generation migraine drug is about 50 percent more effective than the nasal spray placebo for Sumatriptan.
It seems that more pain or exposure to a treatment increases the placebo effect.
Five Nocebo Examples
1. Poison Ivy Nocebo
A monumental nocebo effect was found in a Japanese study published in 1962 (study).
The study enrolled 13 students that were allergic to a Japanese tree similar to poison ivy. The researchers led the children to believe that they had rubbed the poisonous leaves on their left arms.
Instead, they had rubbed harmless leaves on the children’s left arms. All 13 students had allergic skin reactions consistent with poison ivy. They believed something negative would happen and it physically did.
Poisonous leaves were actually rubbed on the children’s right arms, but they were told that those leaves were harmless. Only two of the children had allergic reactions from the poisonous leaves. The remaining 11 children that believed the leaves were harmless had no reaction to the poisonous leaves.
This study found that the mind is capable of creating or preventing physical harm.
2. Migraine Nocebos
In a study titled “Nocebo Phenomena in Medicine,” migraine treatments were the prime example of how a placebo pill can have negative effects (study).
The study reviewed 69 placebo-controlled trials of multiple migraine medications.
Placebo side effects were so severe that up to six percent of patients had to drop out of each study. Multiple side effects were experienced with the placebo pills and they were consistent with the actual drug tested.
“The side effects of medications therefore depend on what adverse events the patients and their treating physicians expect” according to the authors of the study.
3. A Poor Placebo is a Nocebo
B vitamins are critical for migraine prevention (full article).
One study found that migraine disability was cut in half within six months of B vitamin supplementation (study link). However, the placebo had no effect.
Some placebos reduce the majority of migraines or even completely eliminate migraines in a few patients. Yet, many migraine studies have no placebo effect.
Patients that are given the impression that a treatment is weak will have poorer health outcomes.
4. Dying from a Broken Heart
Dying of a broken heart is also a nocebo. I witnessed this often in the fire service.
Widows and widowers have a 66 percent increased chance of dying within three months of a spouse passing away (study).
Moreover, the death of a spouse increases the risk of dying from cancer, infections, cardiovascular disease, and numerous other illnesses (study).
The will to live has a deep impact on health.
5. Voodoo Death
The most infamous nocebo was a case study of a man that was diagnosed with terminal cancer.
After his death, the autopsy revealed that the cancer was insignificant and not the cause of his death.
Researchers believed that “the man’s belief in his imminent death was the cause of his death itself” (study). Being told you will die and then actually dying is known as a Voodoo death.
How to Use Placebos
The positive expectation of migraine treatments has led to reductions in migraine frequency and even complete migraine remission.
Negative expectations can reduce the effectiveness of a migraine treatment and even produce side effects that are consistent with the actual migraine drug.
Multiple pills or exposures to a placebo increase its effectiveness.
Take multiple breaks per day to breathe, meditate, consume migraine prevention nutrients, or undertake any type of treatment. Real or fake. Spend time believing that the treatment will work. Look at what happiness experts say you should do to stay positive (Shawn Achor’s Ted Talk)
It’s probable that some patients given a placebo or drug don’t expect it to actually work.
There is a possibility that every migraine sufferer could harness the power of the placebo effect by simply believing in their treatment of choice.
Placebos are a real medical effect found in a wide variety of treatments and confirmed in thousands of studies.
Use placebos to your advantage.