Placebo Effect: In the Brain, Not the Mind

Many of us learned in high school biology that the placebo effect is when you think that a treatment is effective even though the treatment or medication is an inactive form of treatment. You think you will feel better, so you believe that you are better.

High school biology was wrong. Studies using sophisticated brain scanning equipment have shown that when participants believed a medication would ease pain, the brain releases endorphins and opioids, the brain’s natural painkillers.

PET scans turned up differences in brain activity. Those who reported pain relief after taking the placebo showed increased activity in parts of the brain associated with modulating pain. A radioactive tracer also revealed that binding occurred at receptors for naturally occurring pain-fighting endorphins.

“If somebody believes something will work,” says Zubieta, “that positive expectation by itself, through different connections in the brain, activates mechanisms that suppress pain. We saw a linear relationship between how people reported pain and how their brains released opioids.

People Need Both Drugs and Faith to Get Rid of Pain is an excellent article explaining current and past placebo research and understandings.

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Botox Doesn’t Relieve Migraines & Tension-Type Headaches?

A review of all available data on treating migraines and tension-type headaches with Botox indicates it is no better than a placebo, according to a US News & World Report article. The findings are included in guidelines for using Botox published in today’s issue of the journal Neurology.

Botox Works on Muscle Disorders But Not Migraines

[B]otulinum toxin has become an effective treatment for numerous movement disorders associated with excessive muscle contraction.

The new guidelines approve its use for treating cervical dystonia, a condition of involuntary head tilt or neck movement; involuntary facial contractions, involuntary eye closure, focal limb dystonias (such as writer’s cramp), essential tremor and some spastic bladder disorders. The drug is injected directly into affected muscles.

[non-contiguous paragraphs]

The finding that botulinum toxin probably does not help relieve migraine or chronic tension headaches surprised the researchers.

“Based on currently available data, botulinum toxin injections should not be offered to patients with episodic migraine and chronic tension-type headaches,” pain guidelines author Dr. Markus Naumann, head of the Department of Neurology at Augsburg Hospital in Germany, said in a prepared statement. “It is no better than placebo injections for these types of headache.”

I haven’t even found the abstract yet. I’ll let you know as soon as I learn more about this surprising report. If you know anything about it, please leave a comment below.

Migraine’s Visual Aura & Hallucinations on the New York Times Migraine Blog

The deep explorations of visual aura and hallucinations in the two latest entries on the New York Times migraine blog provide education far beyond what most migraineurs encounter; including one who writes about headache disorders and migraines nearly every day (me!). Check out the following posts to expand your knowledge.

Patterns
Acclaimed writer and neurologist and migraineur Oliver Sacks explains the neurophysiology of visual auras and describes the patterns, or “geometric hallucinations,” some see during an aura. His intricate depiction is a fascinating eye-opener for those without aura and excellent information for those with it.

Lifting, Lights and Little People
Siri Hustvedt, author and migraineur, wrote of the hallucinations she has had with migraine episodes.

It is comforting to think that visual perception is a matter of taking in what’s out there, that a clear line exists between “seeing things” and the everyday experience of looking. In fact, this is not how normal vision works. Our minds are not passive containers of external reality or experience. Evidence suggests that what we see is a combination of sensory information coming in from the outside, which has been dynamically translated or decoded in our brains through both our expectations of what it is we are looking at and our human ability to create coherent images. We don’t just digest the world; we make it.

You can hear more from New York Times migraine bloggers Siri Hustvedt and Paula Kamen on NPR’s Talk of the Nation. Headache specialist and founder of the Michigan Headache and Neurological Institute Joel Saper weighed in and responded to callers’ questions. Congratulations to Migraine Blog, Migraine Chick and Somebody Heal Me for being mentioned on NPR’s website.

A Reader’s Story: Living With New Daily Persistent Headache

Andy recently “celebrated” his third year anniversary of having a constant headache. He’s determined to keep it from defining who he is, which we all know is a constant struggle.

I woke up with a headache on January 22, 2005 and it’s been there ever since. I also determined through my own research that it is New Daily Persistent Headache — it has the symptoms of chronic daily headache without the traditional migraine elements.

Most days it’s pretty mild, allowing me to live my life fairly normally as long as I’m distracted by my job, family, baseball game, etc. But it never goes away. It’s always there, and it’s really devastating to think I’ll be spending the next 50 years of my life in pain. 50 years! See how terrible that sounds? I just came across this blog for the first time and it’s somewhat comforting to know there are other people out there who can relate to that. Depressing, yet comforting.

I sometimes wish I would have been in a car accident or suffered some specific traumatic experience so I could at least pinpoint an occurrence and say, “It’s awful, but these things happen.” In my case, all I did was wake up. It’s maddening, but I try not to let it define who I am.

Like others, I’ve spent the past several years seeing many specialists and trying dozens of medications — all to no avail. I’m currently taking an extended-release form of Tramadol (and Vicodin every few days) but aside from offering a few hours of slight relief, they just make me fatigued like most of the other meds I’ve tried.

We’re all in this together, which is why it’s so important to hear stories from many different people. If you’d like to share your story with readers and me, please e-mail me or leave a comment.

For more information, see the National Headache Foundation on new daily persistent headache and Her Life in a Nutshell, a blog about the disorder.

Self-Compassion: Life’s Easier When You’re Nice to Yourself

My massage therapist and I talked about self-compassion — and how little I have — for most of my last 90 minute massage. I wrote this post in 2005 and have improved some, but have a long way to go. (As evidenced by my evaluation of my progress toward self-compassion.

Having Compassion. . . For Yourself

A new study indicates that having compassion for oneself may help people deal with life’s difficulties. Although the examined specific instances of failure, the findings may also help us learn to live with illness. Not that we’re failures because we’re sick, but that the self-blame that chronic illness invites is similar.

When Life Is Rough, Self-Compassion May Help: To Bounce Back, Cut Yourself Some Slack, Study Shows

“If life is a journey, we all run into potholes, and new research shows that those jolts might not be so bad if you treat yourself with compassion.

“In other words, lighten up on yourself when failure comes your way. Self-compassion might even help more than high self-esteem, report researchers from Wake Forest University.”

I hadn’t thought of it as self-compassion, but one of my newer methods for coping with headache is to try to avoid blaming or criticizing myself for having them or for letting them affect my life. Notice the words “try to” in that sentence. Success is often elusive, but I don’t berate myself as often or as severely as I once did. These baby steps feel like a huge accomplishment. And I’m much more comfortable in my skin if I have compassion for myself.

(To read more details of the study, see Psychologist Finds Self-Compassion Helps People Cope with Failure)

Nominate Your Headache Care Provider for The National Headache Foundation’s Healthcare Provider of the Year Award

There’s still time to nominate your favorite headache care provider for the National Headache Foundation‘s Healthcare Provider of the Year Award. Submissions are due March 14.

The National Headache Foundation Healthcare Provider of the Year Award recognizes an outstanding healthcare provider. The award is open to physicians, physician assistants, nurse practitioners and nurses serving patients with headaches and practicing in the United States or U.S. territories. Patients, friends and co-workers may nominate healthcare providers. A selection committee compiled by the National Headache Foundation will judge nominations based on the following criteria:

NOMINATION CRITERIA

Scope of Care
Nominee must be a physician, physician assistant, nurse practitioner or and nurse who cares for or serves patients with headaches.

Quality of Care
The nominee must demonstrate a high level of clinical expertise and a commitment to improving healthcare delivery to headache sufferers.

Dedication
The nominee must have demonstrated extraordinary dedication to patients with headaches during the year and throughout his or her career.

The Healthcare Provider of the Year Selection Committee will review all nominations. Current members of the National Headache Foundation board of directors and staff are not eligible to participate as nominees in the Healthcare Provider of the Year program.

The nomination form (with applicable attachments) must be postmarked or received at the National Headache Foundation office no later than March 14, 2008.

Nominations can be submitted via email to nhf1970@headaches.org. Completed nomination forms can also be mailed to:

National Headache Foundation – Healthcare Provider of the Year
820 N. Orleans, Suite 217
Chicago, IL 60610-3132

For additional information, please call (888) NHF-5552 or email info@headaches.org.

Nomination Form (Word file)
Nomination Form (PDF)

The Great Pillow Experiment: Results Not Encouraging

Pillow_neckMy joy following the Great Pillow Experiment was sadly short-lived. The day of my original post was the best and the next day was pretty good. The relief dropped dramatically and I haven’t found it since. That was almost four weeks ago.

I tried a new pillow combination three nights ago. My neck and shoulder pain has lessened. While the chronic daily headache is unchanged, the migraine episodes haven’t been as severe as they were the past couple weeks.

If this doesn’t pan out, I’m not sure what’s next. My sensitivity to odors rules out memory foam, latex and the synthetic filling of most pillows. I’ve tried wool, buckwheat, down, and organic cotton over buckwheat, all to no avail. These fibers may be perfectly fine, but the pillow construction is never right.

The pillow of my dreams is shaped kind of like a memory foam pillow. There’s a densely stuffed ridge at the bottom to hold my neck in the right position and a dip above to keep my head at the correct angle. Maybe I should build my own.