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Evidence summaries

Normobaric and Hyperbaric Oxygen Therapy for the Treatment and Prevention of Migraine and Cluster Headache

Hyperbaric oxygen therapy (HBOT) may be effective for the termination of acute migraine, and normobaric oxygen therapy (NBOT) may be similarly effective in cluster headache. Level of evidence: "C"

Cochrane review[Abstract]1 included 11 trials with 209 participants. Five trials (n = 103) compared HBOT vs. sham therapy for acute migraine, 3 trials (n = 145) compared NBOT to sham therapy or ergotamine tartrate for cluster headache, two trials evaluated HBOT for cluster headache (n = 29), and one trial (n = 56) compared NBOT to sham for a mixed group of headache.

  • Migraine: The pooled data from 3 trials suggested that HBOT was effective in relieving migraine headaches compared to sham therapy (RR 6.21, 95% CI 2.41 to 16.00; 3 trials, n = 58). There was no evidence that HBOT could prevent migraine episodes, reduce the incidence of nausea and vomiting, or reduce the requirement for rescue medication.
  • Cluster headache: There was no evidence that HBOT was effective for the termination of cluster headache (RR 11.38, 95% CI 0.77 to 167.85; one trial; n = 13).NBOT was effective in terminating cluster headache compared to sham (RR 7.88, 95% CI 1.13 to 54.66; one trial, n = 19), but not superior to ergotamine administration in another trial (RR 1.17, 95% CI 0.94 to 1.46; n = 100). A third trial reported a statistically significant difference in the proportion of attacks successfully treated with oxygen (117 of 150 attacks were successfully treated with NBOT (78%) vs. 30 of 148 attacks treated with air (20%)). The proportion of responders was consistent across these 3 trials, and suggested that more than 75% of headaches were likely to respond to NBOT.No serious adverse events during HBOT or NBOT were reported.

Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment, high drop-out rate) and imprecise results (few patients in each comparison).

    References

    • Bennett MH, French C, Schnabel A et al. Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. Cochrane Database Syst Rev 2015;12():CD005219. [PubMed].

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