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Expectations Influence Effectiveness of Migraine Medication

Patients’ expectations influenced the effects of both medications and placebos in a recent study and highlighted the importance of the power of suggestion in the field of medicine.

Researchers studied 66 migraineurs over the course of more than 450 migraine attacks and found that when they provided positive information about a placebo and the common migraine medication Maxalt (rizatriptan), the effectiveness of both increased. This observation suggested that a positive message and a powerful medication are important in improved quality clinical care.

Overall, the study, which was conducted at the Beth Israel Deaconess Medical Center (BIDMC) in Boston, found that the benefits of rizatriptan increased when researchers told patients they were receiving an effective treatment of acute migraine. Additionally, when researchers switched the identities of the pills, patients reported that both the migraine medication and the placebo reduced their pain.

“Even though Maxalt was superior to the placebo in terms of alleviating pain, we found that … the placebo effect accounted for at least 50 percent of the subjects’ overall pain relief,” said senior author Ted Kaptchuk, Director of the Program in Placebo Studies and Therapeutic Encounter (PiPS) at BIDMC and Harvard Medical School. “When, for example, Maxalt was labeled ‘Maxalt,’ the subjects’ reports of pain relief more than doubled compared to when Maxalt was labeled ‘placebo.’ This tells us that the effectiveness of a good pharmaceutical may be doubled by enhancing the placebo effect.”

In a surprise to the researchers, patients also reported pain relief even at those times when they knew the pill they were receiving was a placebo. However, it is not clear to the researchers why this occurs. More research is needed in this area, they said, so that the placebo effect might be used to benefit patient care.

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