Probable medication-overuse headache: The effect of a 2-month drug-free period
MarcGotkine, Department of Neurology, Hadassah University Hospital, P.O. Box 12000, Jerusalem 91120, Israelmarcgotkine@gmail.com
Submitted August 31, 2006
I read the article by Zeeberg et al [1] with interest in which they
emphasize the therapeutic importance of weaning patients suspected of
suffering from medication overuse headache (MOH). Do the authors feel there
is a possibility that the observed improvement in headache could be partially due to an "inverse" placebo effect?
The placebo effect can be
defined as "improvement in the condition of a patient that occurs in
response to treatment but cannot be considered due to the specific
treatment used." [2] Patients expecting an improvement in symptoms
following the specific treatment of drug withdrawal may experience such an
effect. It is scientifically appealing to conduct a double-blind
controlled trial in which the "placebo" arm consists of patients
continuing active pharmacological therapy while patients in the "active
treatment" arm receive an inert substance.
Although this is arguably the
ideal way to establish MOH as a distinct clinical entity, the authors'
pragmatic approach provides convincing evidence guiding the management of
this problematic clinical situation.
References
1. Zeeberg, P., J. Olesen, R. Jensen. Probable medication-overuse headache: the effect of a 2-month drug-free period. Neurology 2006;66:1894-1898.
2.
Medline Plus Merriam Webster Dictionary. http://www2.merriam-webster.com/cgi-bin/mwmednlm?book=Medical&va=placebo%20effect. Accessed August 31, 2006.
Disclosure: The author reports no conflicts of interest.
I read the article by Zeeberg et al [1] with interest in which they emphasize the therapeutic importance of weaning patients suspected of suffering from medication overuse headache (MOH). Do the authors feel there is a possibility that the observed improvement in headache could be partially due to an "inverse" placebo effect?
The placebo effect can be defined as "improvement in the condition of a patient that occurs in response to treatment but cannot be considered due to the specific treatment used." [2] Patients expecting an improvement in symptoms following the specific treatment of drug withdrawal may experience such an effect. It is scientifically appealing to conduct a double-blind controlled trial in which the "placebo" arm consists of patients continuing active pharmacological therapy while patients in the "active treatment" arm receive an inert substance.
Although this is arguably the ideal way to establish MOH as a distinct clinical entity, the authors' pragmatic approach provides convincing evidence guiding the management of this problematic clinical situation.
References
1. Zeeberg, P., J. Olesen, R. Jensen. Probable medication-overuse headache: the effect of a 2-month drug-free period. Neurology 2006;66:1894-1898.
2. Medline Plus Merriam Webster Dictionary. http://www2.merriam-webster.com/cgi-bin/mwmednlm?book=Medical&va=placebo%20effect. Accessed August 31, 2006.
Disclosure: The author reports no conflicts of interest.