Placebo Effect Dictates Therapeutic Effect of Headache Medication

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By Dr. Mercola

According to a recent Google query analysis, the 2008 recession took a great toll on Americans’ health.1 Ulcers and headaches topped the charts in terms of ailments people sought advice on.

Interestingly, the rise in such stress-related health problems has turned out to be enduring. According to the lead author:2

“By the end of the great recession in 2011, queries were still substantially higher than before the recession. People were not getting better with the economy. People were potentially much sicker.”

Migraine headache—which is a more severe form of head pain—is actually one of the most common health conditions in the world, regardless of the economic climate.

It’s more prevalent than diabetes, epilepsy and asthma combined.3 It’s also one of the top 20 causes of disability among adults. An estimated 26 million Americans suffer with migraines, and approximately 80 percent of them are women.4

Economic Woes Fuel Ulcers and Headaches

The first featured study, published in the American Journal of Preventive Medicine,5 analyzed the number of Google queries for each of the top 100 health-related search terms made between December 2008 and December 2011. They then compared this to the number of queries for each search term made prior to the recession.

Compared to pre-recession data, certain ailments skyrocketed during the years of the recession. Stomach ulcers rose 228 percent (1.48 million extra queries), followed by headache symptoms, which rose by 193 percent (1.52 million extra queries). According to the study:

“Google queries indicate that the Great Recession coincided with substantial increases in health concerns, hinting at how population health specifically changed during that time… Among just the top 100, there were roughly 205 million excess health concern queries during the Great Recession.”

Headaches Come in Many Forms

Naturally, there’s a wide range of headaches. Compared to other types of headaches, migraines are still in the minority. Headaches, in general, may result from chemical, environmental, emotional, or physical sources, and/or any combination thereof.

They could be caused by anything from food allergies and sensitivity to scents or perfume, to emotional stress and jaw clenching, hormonal fluctuations, or a shortage of blood or oxygen to your head caused by poor posture.

In the latter case, visiting a chiropractor and learning proper posture techniques could help resolve recurring headaches. If your headache stems from tight muscles, myofascial release may be part of the answer. Electrosensitivity could also be part of the problem, so take note of where you are and what gadgets are nearby when symptoms strike.

A migraine headache is characterized by intense throbbing or pulsing, typically in one area or side of your head, and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound.

Due to its profoundly debilitating nature, this may be one instance where you could justify popping a pill for instant relief. Unfortunately, migraine medications have a particularly poor efficacy rate. Most migraine drugs tend to work only 50 percent of the time, in 50 percent of people… They can also cause severe side effects.

Interestingly, another recent study6 found that expectation appears to play a very important role in how you respond to migraine treatment. And, if the placebo effect is instrumental in alleviating serious migraine pain, it stands to reason that treatment for less severe forms of headache might be influenced in the same manner.

Migraine Study Gives Indication of the Power of Suggestion…

The study7 in question, performed by researchers from Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, is a fascinating demonstration of the power of your mind and the placebo effect. In short, your expectations about the drug you’re given may be just as important as the drug itself when it comes to reaping results. As reported by Science Daily:8

“[The researchers] took advantage of the recurring nature of migraine headaches to compare the effects of drug treatments and placebos in seven separate migraine attacks in each of 66 individuals. Their findings uncovered several key points:

1) The benefits of the migraine drug Maxalt (rizatriptan) increased when patients were told they were receiving an effective drug for the treatment of acute migraine;

2) When the identities of Maxalt tablets and placebo pills were switched, patients reported similar reductions in pain from placebo pills labeled as Maxalt as from Maxalt tablets labeled as placebo; and

3) Study subjects reported pain relief even when they knew the pill they were receiving was a placebo, compared with no treatment at all.”

According to the authors, the placebo effect accounted for more than 50 percentof the therapeutic value of the drug! As explained by co-author Ted Kaptchuk, Director of the Program in Placebo Studies and Therapeutic Encounter at Harvard Medical School:9

“This study untangled and reassembled the clinical effects of placebo and medication in a unique manner. Very few, if any, experiments have compared the effectiveness of medication under different degrees of information in a naturally recurring disease.

Our discovery showing that subjects’ reports of pain were nearly identical when they were told that an active drug was a placebo as when they were told that a placebo was an active drug demonstrates that the placebo effect is an unacknowledged partner for powerful medications.”

Migraine Prevention Strategy #1: Avoid Common Triggers

Besides only working about half of the time in half of those taking them, many migraine medications can also cause intense side effects such as “medication overuse headache,” which often occurs when people take too much of a headache drug.

Worse yet, if you take tryptamine-based drugs, which bind to serotonin receptors to constrict your cranial blood vessels, but your pain is not due to engorged blood vessels, then constricting them can potentially do harm. Serious cardiovascular events, including heart attack and stroke, are in fact side effects of these types of drugs.

Fortunately, there are better ways to treat migraines than pharmaceuticals. Learning how to prevent them from occurring in the first place is your best bet. First, you’ll want to make sure you avoid potential triggers. While there are many potential triggers (and what triggers a migraine for one might not trigger it in another), the following are some of the most commonly reported:

Food and drink: Many people experience migraines when they eat certain foods, especially: wheat, dairy, sugar, artificial preservatives or chemical additives, cured or processed meats, alcohol (especially red wine and beer), aspartame, caffeine, and MSG. Too much or too little coffee/caffeine can also trigger an attack Changes in sleeping cycle: Both missing sleep and oversleeping can trigger a migraine Hormones: Some women experience migraines before or during their periods, during pregnancy or during menopause. Others may get migraines from hormonal medications like birth control pills or hormone replacement therapy
Allergies: Including food allergies and food sensitivities, and chemical sensitivities Stress/Post-stress: Any kind of emotional trauma can trigger a migraine, even after the stress has passed External stimuli: Bright lights, fluorescent lights, loud noises, and strong smells (even pleasant ones) can trigger a migraine
Dehydration and/or hunger.Skipping meals or fasting are also common triggers Physical exertion:Extremely intense exercise or even sex has been known to bring on migraines Weather changes, and/or changes in altitude

 

The Diet Connection

From an anecdotal perspective, the Paleo diet has helped quite a few people rid themselves of recurring headaches, including migraines. The Paleo diet can be summarized as “any food that can be eaten without being processed.” That excludes grains, bread, or pasta, and no pasteurized dairy, but does include lots of fresh fruits and vegetables, some nuts and oils along with wild caught fish, organic pastured poultry, and grass-fed meats.

While the Paleo diet has many benefits, I believe it can be improved upon. The biggest factor is most people on Paleo consume far too much protein. I believe it would be far healthier to swap the protein for healthy fat. Additionally, once you improve your insulin and leptin resistance you no longer need to restrict your starchy carbs as much. You can easily mold your diet around the principles of Paleo eating by following my nutrition plan. In fact, my eating plan typically reduces migraines by about 80 percent, as it virtually eliminates all common food-related causes of headaches.

There’s plenty of research backing up the headache/food allergy connection.10 For example, research published in the journalLancet back in 197911 showed that migraineurs with food antigen immunoreactivity experienced profound relief when put on an elimination diet. Another randomized, double blind, cross-over study published in 201012 found that a six-week long diet restriction produced a statistically significant reduction in migraines in those diagnosed with migraine without aura. Some of the top migraine-inducing foods identified in the medical literature include: 1314

Wheat and gluten Cow’s milk (including yoghurt and ice cream) Grain cereals Cane sugar Yeast
Corn Citrus Eggs Aspartame MSG

 

If you suspect you might have a food allergy, I suggest doing a diet elimination challenge. Simply remove all foods that contain what you believe you might be allergic to and see if your symptoms improve over the next several days. Keep in mind that depending on your typical headache/migraine frequency, you may need to avoid the suspected food for a few weeks in order to evaluate whether it had an effect or not.

To confirm the results, reintroduce the food or drink (on an empty stomach). If the suspected food is the culprit, you will generally be able to feel the symptoms return within an hour, although migraines can sometimes have a longer lag time than, say, bloating or drowsiness.

Headaches May Be Caused by Common Nutritional Deficiencies

Nutritional deficiencies can also play a major role in headaches and migraines. According to experts like Dr. Robert Barry, one particularly important underlying problem involved with migraines is mitochondrial dysfunction. Ubiquinol—the reduced form of Coenzyme Q10—plays a vital role in ATP production, which is the basic fuel for your mitochondria. Your body does produce ubiquinol naturally. In fact, it is the predominant form in most healthy cells, tissues and organs. However, with rampant pollution and poor diet, mitochondrial dysfunction has become increasingly common, warranting supplementation with either ubiquinol or CoQ10.

One study published in the journal Neurology15 found that CoQ10 was superior to a placebo in preventing migraines and reducing severity. Of the patients who received 100 mg of CoQ10 three times a day, 50 percent reported significantly reduced frequency of headaches compared to only 14 percent of those who took the placebo. Other research has shown that ubiquinol, the reduced form of CoQ10, is far more effective than CoQ10 due to its superior bioavailability, so while it costs a bit more, it may provide you with better results.

Vitamin D deficiency can also play a role. According to research presented at the 50th Annual Meeting of the American Headache Society16 (2010), nearly 42 percent of patients with chronic migraine were deficient in vitamin D. The study also showed that the longer you suffered from chronic migraines, the more likely you are to be vitamin D deficient. Other vitamin deficiencies linked to headaches include vitamins B2 (riboflavin), B6, B12, and folic acid.

A 2009 study17 evaluated the effect of 2 mg of folic acid, 25 mg vitamin B6, and 400 micrograms of vitamin B12 in 52 patients diagnosed with migraine with aura. Compared to the placebo group, those receiving these supplements experienced a 50 percent reduction in migraine disability over a six-month period. Previous studies, such as a 2004 study in the European Journal of Neurology,18 have also reported that high doses of B2 (riboflavin) can help prevent migraine attacks. For example, in one study patients who received 400 mg riboflavin per day experienced a 50 percent reduction in migraine frequency after three months.

Magnesium can also be a helpful supplement for headache and migraine sufferers, as it helps relax blood vessel constriction in your brain. The best magnesium supplement I know of is magnesium threonate as it penetrates cell membranes, including the mitochondria. No other magnesium supplement does this. Interestingly, some of the best drugs used to treat migraines are calcium channel blockers, and that is how magnesium works. Supplemental magnesium would be FAR safer than a calcium channel blocker.

Tips and Tricks for Immediate Relief Without Drugs

While prevention is key, you’re not stuck with the drug paradigm should a headache strike. For acute situations, there are several safe, healthy alternatives that you can try. I recommend testing all of them, in various combinations, to find what works best for you. I’ve listed a few below, but please feel free to add any approaches that you have found helpful for the treatment of migraines. There are some really bright people who receive this newsletter and I am sure they have some phenomenal solutions.

  • Try the Emotional Freedom Technique (EFT). This simple process by itself tends to provide relief 50-80 percent of the time and, in some cases, the relief is complete and permanent. More sophisticated uses by a licensed EFT practitioner19may be required for some migraine sufferers.
  • Stimulate your body’s natural painkilling ability. By putting pressure on a nerve just under your eyebrow, you can cause your pituitary gland to release painkilling endorphins immediately. Massaging your ears, ear lobes, and the “crown” of your head — the ring of muscles that circle your head where a crown would sit—can also provide some relief.
  • Apply hot and cold packs. For some people, heat will do the trick, while others get more relief from cold. Experiment to see which one works for you, but avoid extreme temperatures. Alternating between the two may also work. Placing your hands and feet in hot (but not scalding) water, while placing a cold pack at the base of your skull, is yet another trick that works for some.
  • Take anywhere from 1/2 to 3 teaspoons of cayenne pepper in an 8 oz glass of water (hot or cold). Endorphins are released by your brain when the cayenne hits your stomach lining. Another alternative is to swallow a dollop of wasabi paste.
  • Sniff green apple scent. One study found that the scent significantly relieved migraine pain. This may also work with other scents that you enjoy so consulting with an aromatherapist might be beneficial. Other aromas that stand out of the crowd include peppermint, sandalwood, lavender, and eucalyptus.

Your Mind as a Powerful Ally

Preventing migraines and other recurring types of headaches begins by avoiding the triggers. Most often this means eating healthy whole foods (avoiding most processed ones) and managing your stress effectively. Following my eating plan has provided relief for many, although it’s not an overnight cure. Dietary changes do take some time to reveal its benefits. Avoiding wheat, grains, sugar, and all fluids but water seem to be particularly effective.

Regular exercise may also help to keep headaches and migraines at bay by improving your response to stress along with the underlying inflammatory conditions that can trigger them. Ideally, these are the lifestyle strategies to focus on if you suffer from recurring headaches. That said, should a headache strike and you need immediate relief, try one or more of the tips and tricks listed above.

Also consider whether your headaches may be precipitated by poor posture, or being surrounded by too many electrical gadgets or Wi-Fi. If you think either of those issues is at play, consider the appropriate remedies to address them. For the former, consider seeing a qualified chiropractor and adapt a regimen to address your posture. Two of my favorite strategies for correcting postural problems are The Gokhale Method and Foundation Training.

If you think you may be electrosensitive, addressing your use of electronics, such as your cell phone and computer, will be the order of the day. To learn more, you can find a large number of articles on this issue on my dedicated EMF page.

Sources and References

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