A meta-analysis published in Jama confirms the beneficial effect of placebo in more than half of cases. But, paradoxically, this good result paralyzes research.
One in ten children suffer from migraine. Whether punctual or deep, it does not manifest itself in the same way as in adults. For parents, the diagnosis is often difficult to establish. The seizures are shorter in duration and the child does not always have a headache. He has uncontrollable vomiting which can last for several hours and has abdominal pain.
Listen to Dr Anne Ducros, neurologist, headache emergency, Lariboisère hospital (Paris): “ The headache is not daily but does not come with a crisis and is accompanied by fatigue ”.
The treatment of pediatric forms of migraine is also problematic. It is even “a major clinical stake”, recognizes the journal Jama Pediatrics which publishes on its site two compliation of studies on the pharmacological approach of the crisis and the basic treatment in the migraine of the child. These meta-analyzes show that the placebo effect is effective in 55% of cases, that is to say that it decreases the headache within two hours of the attack. Reassuring news for parents and the attending physician who can often relieve the child with paracetamol and explanations on the origin of migraine.
Listen to Dr Anne Ducros: More than 50% improvement with paracetamol and a very light disease-modifying treatment without adverse effects
But the medal has its flip side. As the placebo effect is major in children, it slows down research on new drugs. In clinical trials, molecules must indeed demonstrate greater efficacy than placebo. A difficult goal to achieve.
Listen to Dr Anne Ducros: “ The demonstration of a drug is hampered because of the placebo effect “.
Suddenly, the therapeutic arsenal is limited to calm these persistent migraines. Only two molecules demonstrated superiority over placebo.
Listen to Dr Anne Ducros: One of the two molecules is not available in France
For Dr Anne Ducros, industry and researchers must not give up. The specialists recommend that new studies be conducted by further analyzing the placebo effect. For its part, the High Authority for Healthé recognized in 2002 that non-drug treatments, such as relaxation and cognitive and behavioral therapies were effective.
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