Dimos D. Mitsikostas – författare

This book discusses the role of placebos and nocebos in the treatment of headache disorders. These disorders are usually treatable, but safety and tolerability issues mean that available preventive treatments have often limited success, even in the right hands – one in five patients treated with a migraine preventive pharmaceutical agent discontinues treatment for those reasons. The nocebo effect plays a role here, with patients’ negative expectation and previous unpleasant treatment experiences creating negative belief in the treatment’s benefits and safety, which in turn limits treatment outcomes and adherence significantly. In RCTs on migraine prevention, one in 20 patients treated with a placebo discontinued treatment because of adverse events, indicating a considerable nocebo effect; the fewer potential adverse events described in the consent form, the smaller the nocebo effect. As such, physicians treating headache sufferers should acknowledge nocebo as a significant cofactorfor treatment adherence and failure, and plan techniques to limit the effects, such as patient education and close follow-up. This highly informative and painstakingly presented book provides scientific insights for professionals and scholars with an interest in internal medicine, neurology and pain medicine.

In this book, headache experts summarize all the currently available therapies for primary headaches and most importantly, describe the ‘tricks’ that can ensure the success of headache pharmacotherapy. Prevention and acute treatment of migraine and cluster headache receive particular attention and individual chapters are devoted to the treatment of primary headaches in special groups, i.e. children, pregnant women and the elderly. Further chapters focus on selected secondary headache disorders and cranial neuralgias for which pharmacotherapy is available. The book is designed to meet the daily practice needs of general physicians, general neurologists, neurologists in training and medical students. Headache remains a leading reason for people to seek medical consultation, and migraine and other primary headache disorders are classified by the WHO as among the most disabling medical conditions in the general population, often affecting individuals during their most productive years. Unfortunately, under treatment and mismanagement are the fate of many headache patients and this book provides a sound basis for optimizing treatment.