A Meta-Analysis of the Placebo Response in Acute Migraine and How This Response May Be Influenced by Some of the Characteristics of Clinical Trials

Eur J Clin Pharmacol. 2006 Mar;62(3):161-72. doi: 10.1007/s00228-005-0088-5. Epub 2006 Jan 10.

Abstract

Migraine is the most common cause of vascular headache and a highly prevalent illness. In the last 20 years, the discovery of new agents has increased clinical research on migraine. In most of clinical trials that have been conducted, the efficacy was established using a placebo as a control treatment. The objective of the study reported here was to analyse the response rate in patients who received a placebo as well as to determine how a number of the methodological factors may affect the effect of the placebo in clinical trials of acute migraine. Computer-based information searches were conducted on the Medline database. Data analysis included the outcomes 'pain relief', 'pain-free', 'associated symptoms', 'recurrence', 'patients' opinion' about pain relief and 'adverse events'. Administration route, study design and country in which the study was carried out were the methodological factors that were analyzed. Meta-analysis was computed using Mantel-Haenszel, and a total of 98 papers were considered in the final analysis. After 2 h, 28.6% of the patients of the placebo group improved and 8.8% were pain-free. The percentage of pain-free patients was the highest in the placebo and active drug groups in which the placebo or drug had been administered subcutaneously, in parallel design studies (vs. cross-over trials) and in studies performed in Europe (vs. North America). Adverse events in the placebo group were significantly higher in studies performed in North America. These data reinforce the need for knowing the magnitude of the placebo response in each specific situation during the planning of clinical trials on acute migraine.

Publication types

  • Meta-Analysis

MeSH terms

  • Acute Disease
  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Europe
  • Female
  • Humans
  • Hyperacusis / complications
  • Hyperacusis / drug therapy
  • Male
  • Migraine Disorders / complications
  • Migraine Disorders / drug therapy*
  • Nausea / complications
  • Nausea / drug therapy
  • North America
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / statistics & numerical data
  • Pain Measurement / drug effects
  • Pain Measurement / methods
  • Photophobia / complications
  • Photophobia / drug therapy
  • Placebo Effect
  • Randomized Controlled Trials as Topic / methods*
  • Randomized Controlled Trials as Topic / standards
  • Randomized Controlled Trials as Topic / statistics & numerical data
  • Recurrence
  • Tryptamines / adverse effects
  • Tryptamines / therapeutic use

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Tryptamines