Placebo Response in a Patient with Chronic Migraine and Ergotic Overuse

Abstract

Facilitation of nociceptive systems has been implicated in Chronic-Migraine pathogenesis. Daily consumption of medication may be a contributing factor. The patient was male, aged 76 years, with history of migraine without aura. Six years ago, he presented with a mild-moderate daily pulsating headache. He was overusing analgesics and ergotamine. After withdrawing, the patient started a nonpulsating headache, diffuse and constant. During follow up, he was refractive to several symptomatic and prophylactic treatments. When we treated him with placebo capsules, the headache responded very well. At first, pain-relief occurred for 6 h and progressively, extended. Two years later, when our patient started to use transdermal patches of fentanyl for treatment of a complex regional pain syndrome type 1, his headache did not improve. Patient has maintained prolonged response to placebo. Actually, he is pain-free for 2-3 days with 1 placebo capsule. We discuss mechanisms of chronic-migraine, drug-overuse, drug-induced headache and placebo addiction. Powerful psychological mechanisms could determine response to placebo in this patient.

The Impact of Topiramate on Health‐Related Quality of Life Indicators in Chronic Migraine

“…A high placebo response is not uncommon in headache trials and may be influenced by several factors, including the patient's expectations and beliefs, and the doctorpatient relationship. 29,30 Furthermore, a certain proportion of patients in the present trial can be classified as having medication-overuse headache. 2 De-escalation of any overused medications in the placebo group may have also contributed to improvements in headache frequency, and concurrent improvements in quality of life measures.…”

Lessons from placebo effects in migraine treatment

“…Even so, there are, inevitably, exceptional cases, as shown by the interesting report by Pascual-Lozano et al [21], of a patient whose migraine, repeatedly refractory to analgesics, NSAIDs, ergotamine and opioids, responded well and consistently to placebo.…”

Placebo, chronic daily headache, and pain: Ten points to ponder

“…Placebo treatment was initiated when he failed to respond to other medications. While responding to placebo, this gentleman reported no headache improvement from transdermal fentanyl that was introduced to control a complex regional pain syndrome type 1 [10]. 7.…”

“…This study raises some important questions regarding whether single-blind placebo baselines, designed to eliminate placebo responders, also could exert a negative influence on the response to the subsequently introduced active treatment. 10. The placebo response in analgesia is related to activation of endogenous µ-opioid receptors.…”