There is no drug, not even aspirin that does not have side-effects. It has been estimated that nearly one-third of all illnesses are iatrogenic, i.e. due to drugs. For this reason, most sufferers would prefer to do without drugs if possible. There are two main approaches to therapy: first, prevention and, second, treatment of the symptoms as soon as they occur. The majority of sufferers from migraine does not go to their doctor and will only do so if the frequency of the headaches suddenly increases. This increase may be due either to an alteration in life circumstances, e.g. increasing stress, or increased exposure to particular precipitants. There may also be a combination of the two, for example, when someone whose headaches are made worse by tobacco smokes more under stress; the combination of these two factors, smoking and stress, is likely to aggravate migraine more than either one singly.
The placebo responseThe word placebo means T will please’. It is used to describe a response found with many illnesses including, surprisingly, serious ones, namely the tendency of the patient to get better on treatment which theoretically should have no effect at all. Because the patient believes that the treatment is helping, he is helped because symptoms disappear; indeed occasionally ‘physical’ (organic) lesions have been known to diminish, showing the close relationship between the mind and body. Some types of faith-healing probably work in this way, fortifying the patient, boosting confidence that something is being done, and increasing the body’s recuperative powers. There is no doubt that the psychological status of a person affects many of the body’s mechanisms.The placebo response is influenced to a great extent by the attitudes and personality of the attending therapist and this is illustrated by the two following cases:A 30-year-old housewife had headaches of increasing frequency and intensity. Her 4 1/2-уear-old daughter was suffering from feeding problems and the woman was becoming increasingly frustrated and angry so that at times she assaulted the child physically. During her first clinic visit the woman confessed her problems to a friendly and sympathetic physician and, by the end of the interview, was much relieved. A remission from headaches of several weeks followed. At her next visit the physician adopted a stern and critical attitude and, ten minutes later, she began to have a severe migraine which responded to the injection of ergotamine.A 44-year-old woman had frequent migraine attacks. She was given a box of placebo pills with words of kindness, reassurance, and indications of extreme interest. It was also emphasized that she had no serious structural defect or tumour, and she left the clinic feeling relaxed and secure. For six weeks following the interview she was headache-free, but gradually the condition began to creep back.This case history exemplifies a characteristic of migraine. It is quite common for a migraine sufferer to respond very well initially to any new therapeutic regime, but it is nearly as common for the headaches to return subsequently as badly as ever. The explanation is that the initial placebo response wears off and indicates that the treatment has had no specific effect of its own. Another interesting feature is the amazing variety of totally different drugs which seem to be effective in the treatment of migraine. It is for this reason that claims of success for a particular form of treatment have to be carefully analyzed. The more attention and interest a patient gets, the greater the placebo effect will be. To some extent this may explain the good effect of certain dietary treatment or, indeed, any treatment in which the patient obtains a good deal of attention.

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