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Effect of different non-pharmacologic placebo treatments on migraine prevention: a network meta-analysis of randomized controlled trials

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Abstract

Background

Placebo control plays an important role in evaluating the effectiveness of interventions. Specifying differential effects of various placebo controls on migraine prevention would be essential in the explanation of preventive treatment for migraine and the indirect comparison between different prophylactic therapeutics.

Objectives

To access the impact of different non-pharmacologic placebo types on different outcomes in migraine patients.

Methods

We searched PubMed, Cochrane Controlled Register of Trials, Embase, and Web of Science databases from the date of creation to June 19, 2023. Randomized controlled trials of migraine that included sham intervention of acupuncture or cognitive behavioural therapy (CBT) or non-invasive Vagus Nerve Stimulation (nVNS) or repetitive Transcranial Magnetic Stimulation (rTMS) or transcranial Direct Current Stimulation (tDCS) were conducted. The primary outcome was the migraine days, and the secondary outcomes were the number of migraine attacks, headache days, headache frequency, and responder’s rate. Placebo effects were assessed using five individual placebos for network meta-analysis, using mean differences to measure the relative effect of pair-wise comparisons between interventions.

Result

A total of 50 trials with 4880 subjects were included. Twenty-seven trials were evaluated for low risk of bias. The results of indirect comparisons show that sham rTMS and sham tDCS had optimal and similar effects in reducing migraine days; sham acupuncture has the greatest effect on reducing the number of migraine attacks and relieving headache frequency; sham rTMS had a highly significant advantage in reducing headache days compared with the other placebo controls.

Conclusion

Based on the network meta-analysis results, we found that sham acupuncture had the greatest effect on migraine prophylaxis. The strong placebo effect of sham acupuncture should be considered when assessing the therapeutic effect.

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Data availability

The data that supports our study are shown in the article and supplementary material, further inquiries can be directed to the corresponding author.

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Funding

HZ received a Grant from the Sichuan Youth Science and Technology Innovation Research Team (No. 2021JDTD0007).

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Authors and Affiliations

  1. The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Wenjiang District, Chengdu, 611100, China

    Yan-Bing Huang, Lu Yuan, Xin-Yu Xiao, Xiao-Ying Wang, Si-Jia Feng & Hui Zheng

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  2. Lu Yuan
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Contributions

YB-H study selection, analyzed and interpreted the data, drafted the manuscript for intellectual content. LY study selection, data extraction, quality assessment, critical revision of the manuscript for important intellectual content. SJ-F data extraction, quality assessment, and critical revision of the manuscript for important intellectual content. XY-X, XY-W critical revision of the manuscript for important intellectual content. HZ study design and conceptualization, critical revision of the manuscript for important intellectual content. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have also agreed to submit for publication.

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Correspondence to Hui Zheng.

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Huang, YB., Yuan, L., Xiao, XY. et al. Effect of different non-pharmacologic placebo treatments on migraine prevention: a network meta-analysis of randomized controlled trials. Acta Neurol Belg (2024). https://doi.org/10.1007/s13760-023-02460-2

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