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Nocebo in headache.

Dimos D Mitsikostas1

  • 1Department of Neurology, Athens Naval Hospital, Athens, Greece.

Current Opinion in Neurology
|March 2, 2016
PubMed
Summary
This summary is machine-generated.

Nocebo, or adverse events from placebo, affects headache patients, especially in preventive treatments. A new questionnaire (Q-No) shows promise in predicting these nocebo effects.

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Area of Science:

  • Neurology
  • Psychosomatic Medicine

Background:

  • Nocebo is the adverse effect experienced by patients receiving a placebo.
  • It significantly impacts treatment adherence and outcomes, particularly in headache disorders.

Purpose of the Study:

  • To review the phenomenon of nocebo in headache patients.
  • To analyze the incidence and characteristics of nocebo in migraine and tension-type headache trials.
  • To introduce a tool for predicting nocebo effects.

Main Methods:

  • Meta-analyses of randomized trials for migraine prevention.
  • Analysis of adverse events in placebo groups.
  • Development and validation of the 4-item questionnaire (Q-No).

Main Results:

  • Eight out of 20 placebo-treated patients experienced adverse events in migraine prevention trials.
  • One out of 20 placebo patients withdrew due to adverse events.
  • The Q-No questionnaire demonstrated 72% specificity and 67% sensitivity in predicting nocebo.

Conclusions:

  • Nocebo significantly impacts headache treatment outcomes, often mirroring expected side effects of active drugs.
  • Botulinum toxin A showed the lowest nocebo effect in migraine prevention.
  • The Q-No questionnaire can aid in predicting nocebo, but individualized prevention strategies are crucial.