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The Sugar Pill Effect
You’ ve heard of placebos. They’ re the sugar pills, the magic crackers— capsules or foods that contain no medication and are used as the control in clinical trials. Scientists in the past have debated the ethics and efficacy of allowing people to think they are receiving medication when they are not.
But recent research suggests there is a true psychological and neurophysiological response to placebos even when the patient knows he or she is being duped. Studies say placebos work because 1) it involves a physician caring for a patient, a relationship that patients need in order to feel they’ ve received help, 2) positive beliefs about outcomes can lead to good outcomes and 3) repetition works— if we think the sugar pill worked the first time, we’ ll get relief each time we use it. According to commentary published in the December 2011 issue of JAMA,“ developments in research on placebos suggest that the time has come to translate the science of placebo effects and knowledge regarding techniques for promoting placebo responses into clinical practice and medical education.”
BY THE NUMBERS
Girls who experience a traumatic brain injury( TBI) are more likely to have headaches following the injury than boys, according to a December 2011 study published in the journal Pediatrics. Adolescents are also more likely to have headaches following such an injury compared to younger children.
43 % of children reported headaches three and 12 months after mild TBI 37 % of children reported headaches after moderate to severe TBI 59 % of girls reported headaches after mild TBI
DEMOGRAPHICS MOST AFFECTED BY CHRONIC MIGRAINE:
In the United States, chronic migraine affects:
2 % of women in their 20s, 30s and 40s
FAST FACT:
Younger patients are more likely to experience pain relief after receiving a placebo than older patients, according to a study published in the
July 2009 issue of the journal Cephalalgia.
of men ages 40 to 49
1.7 %
of African-American women
. 8 %. 7 %
of African American men
Source: Dawn C. Buse, PhD study funded by a National Headache Foundation grant from Ortho- McNeil Neurologics( http:// www. headaches. org / content / nhf-news-know-january-2012 # four).
An Ounce of Prevention
IN THE NETHERLANDS, where 25 percent of patients with migraine are eligible for preventive treatment, only 8 to 12 percent use preventive medications, according to a recent study published in the January 2012 issue of the Canadian Medical Association Journal. Researchers set out to examine whether educating primary care physicians about headache disorders would cause the doctors to proactively address head pain( rather than just prescribe triptans as pain relievers).
HIV AND HEADACHE
Complaints of headache among HIV / AIDS patients are common. According to research published in the November 2011 issue of the journal Headache, more than 50 percent of HIV / AIDS patients experience headache. Of those with headache, 85 percent meet the criteria for migraine.
The research suggests that HIV / AIDS patients are 13 times more likely to experience chronic migraines than the general population. For patients with HIV, researchers found a correlation between an increased number of infected CD4 cells— which is how HIV severity is measured— and increased severity of the headaches those patients experienced. Researchers wrote that they hope these findings will lead to improved treatment and reduced medical costs for HIV / AIDS patients with headache.
After educating the primary care physicians, they found that many of the physicians reevaluated their headache patients and prescribed appropriate preventive medications. But the change in prescribing habits had little effect on patients. They still had headaches, and they still took triptans.
The conclusion? Although education seemed to help the primary care physicians with their prescribing habits, preventive medications did not seem to effectively reduce headaches for patients.
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20 HEAD WISE | Volume 2, Issue 1 • 2012 www. headaches. org | National Headache Foundation 21