Clusterheadaches.com Message Board


    
      
        Clusterheadaches.com Message Board
        (http://www.clusterheadaches.com/cgi-bin/yabb/YaBB.cgi)
      

        Cluster Headache Help and Support >> Cluster Headache Specific >> New york times CH
        
(Message started by: MJ on Apr 29^th, 2008, 12:56am)

Title: New york times CH
Post by MJ on Apr 29^th, 2008, 12:56am

http://health.nytimes.com/health/guides/disease/cluster-headaches/managing-cluster-headaches.html

Nice In depth report and review of clusters.

Title: Re: New york times CH
Post by Kevin_M on Apr 29^th, 2008, 7:07am

Good to see.

Quote:

Cluster headaches are difficult to study. First, they are very uncommon, so there are few well-controlled investigations of this problem. Second, the placebo response is very high in studies on cluster headaches, with 7 - 43% of patients responding to dummy treatments.

Seems it might partially contribute to some unusual relief or treatment methods posted at times.

Title: Re: New york times CH
Post by Ray on Apr 29^th, 2008, 7:21am

Following the link to more information produces this longer, more in depth, article:

http://health.nytimes.com/health/guides/disease/cluster-headaches/print.html

Ray

Title: Re: New york times CH
Post by RichardN on Apr 29^th, 2008, 10:28am

Oxygen Therapy

Breathing pure oxygen (by face mask, for 15 minutes or less) is one of the most effective and safest treatments for cluster headache attacks. It is often the first choice. Inhalation of oxygen raises blood oxygen levels, therefore relaxing narrowed blood vessels.

? ? ?

The above was copied from the link Ray posted. There is much good info in both articles . . . and I appreciate the fact that both recognize 02 as viable abortive . . . . and, that most/all the prevents and abortives mentioned have been discussed on this site. BUT . . . "relaxing narrowed blood vessels" . . .? Seems to have been our experience that the 02 constricts the dilated vessels (causing the pressure on the tri-nerve). . . and aborting the attack.

Curious.

Be Safe,

Richard

Title: Re: New york times CH
Post by BMoneeTheMoneeMan on Apr 29^th, 2008, 10:41am

That is pretty unbelievable such a large number of people respond to placebo.
Placebo could be a rabbit's foot or crossing your fingers, and it looks like quite a few people report relief from it.

Title: Re: New york times CH
Post by Superdave on Apr 29^th, 2008, 11:17am

Wow, great article thanks :)

Title: Re: New york times CH
Post by monty on Apr 29^th, 2008, 12:17pm

on 04/29/08 at 10:41:01, BMoneeTheMoneeMan wrote:

That is pretty unbelievable such a large number of people respond to placebo.
Placebo could be a rabbit's foot or crossing your fingers, and it looks like quite a few people report relief from it.

Not an active placebo where believing helps. A statistical placebo that accounts for the randomness of the beast. Give a bunch of episodics an inert substance and some will report improvement simply because the cycle was winding down.

Title: Re: New york times CH
Post by sandie99 on Apr 29^th, 2008, 12:52pm

Thanks for the links! Good piece. :)

Sanna

Title: Re: New york times CH
Post by brewcrew on Apr 29^th, 2008, 2:47pm

Placebo effect can only be accurately measured when every other input is constant. And we all know that isn't the case. Monty's right on the money.

It wouldn't surprise me if each participant had literally dozens of other variable factors that played into the outcome. That's why the number being positively affected by the placebo seems so high.

Title: Re: New york times CH
Post by kevmd on Apr 29^th, 2008, 4:36pm

Strange but I swear that I read somewhere that placebos had very little effect on CH patients. Can't remember the source or if it would have been more reliable than this article but I know I read it somewhere. We all know there is alot of bogus info on CH

Title: Re: New york times CH
Post by brewcrew on Apr 29^th, 2008, 5:26pm

on 04/29/08 at 16:36:30, kevmd wrote:

I don't think I explained myself very well. Placebos probably don't have much effect. But all the other variables can and do. And a lot of them get recorded as "placebo effect."

Does that make more sense?

Title: Placebos
Post by cluster on Apr 30^th, 2008, 7:10am

on 04/29/08 at 17:26:45, brewcrew wrote:

Placebos probably don't have much effect. But all the other variables can and do. And a lot of them get recorded as "placebo effect."

Does that make more sense?

Yes, this makes sense to me. Episodic patients may join a trial and until the testing starts the episode has gone anyway. Hits may also be less than 30 minutes, if treated or not. Primary endpoint: "Improvement" means the patients got used to the pain?

Placebos may have some measurable effect, please see:
http://www.ncbi.nlm.nih.gov/pubmed/11834781?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

The data quoted by the NYT article seems to be from this review (abstract):

Quote:

Placebo response in cluster headache trials: a review.

Nilsson Remahl AI, Laudon Meyer E, Cordonnier C, Goadsby PJ.
Department of Neurology at Karolinska Institutet, Huddinge University Hospital, Sweden.

Probably because of its relative rarity as primary headache, there are few well-controlled clinical trials on cluster headache (CH) patients. Due to the severity of the pain, the placebo response in CH has been considered to be small. During the eighties the first double-blind, placebo-controlled trials were reported, and placebo responses demonstrated. Here we review the placebo response in CH trials in order to assess its magnitude and consider how future studies can be optimized. Six trials were identified with a double-blind, placebo-controlled, cross-over design testing treatments of acute CH. For those with a primary endpoint set to no or mild headache the placebo responses varied from 7 to 42%. In five of seven prophylactic trials, using a double-blind, placebo-controlled, parallel-group design, the placebo was merely used to set a baseline for comparison. The placebo responses were reported in only two trials. Here the response varies from 14 to 43%, the lowest value was reported using the strict endpoint; cessation of headache attacks. We conclude that a placebo response exists in trials of drugs on CH patients. Furthermore, this placebo response is of the same magnitude as that seen in migraine studies. We recommend the use of IHS guidelines when designing new trials. The possibility of a genuine biological mechanism responsible for the placebo response is discussed.

Source: http://www.ncbi.nlm.nih.gov/pubmed/12950375?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

pf wishes,
Friedrich