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December 13, 1985

Migraine Prevention With β-Blockers: A Placebo Effect?-Reply

JAMA. 1985;254(22):3184. doi:10.1001/jama.1985.03360220045025

In Reply.—  Robert J. Gaudet's thoughtful criticism makes valid points about the difficulties of keeping a study truly double-blind. In our evaluation of timolol we did not inform the patients of pulse and blood pressure readings, and there was no reason to think that any of them were monitoring these factors. Nevertheless, we did not actually study this possibility. We agree with Dr Gaudet's implication that patients may, nonetheless, appreciate ill-defined clues that tell them that they are in fact receiving the active drug as opposed to placebo.Several factors argue against Dr Gaudet's conclusion that the β-blockers "may join the 'believe-it-or-not' ranks of other difficult-to-blind migraine treatments." In the first place, in spite of the substantially positive findings on the use of propranolol hydrochloride in migraine,1 other β-blockers including pindolol2 and alprenolol3 have not been found to be effective. Presumably if nonspecific effects are primary, these