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

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].