Hyperbaric oxygen gave some relief from migrainous headache pain but not tenderness.

Clinical Bottom Line:

1. Some evidence that hyperbaric oxygen improves headache severity compared to normobaric oxygen.

2. No evidence of greater improvement in tenderness to palpation/pressure with hyperbaric as compared to normobaric therapy.

Appraised by: Mike Bennett

Dept of Diving and Hyperbaric Medicine

Prince of Wales Hospital

Sydney; Sunday, 06 December, 1998

Clinical Scenario:  A 34 year old female suffering from frequent migraine headaches.

Three-part Question: In migraine headache, does the application of hyperbaric oxygen compared to normobaric oxygen, result in any further improvement in headache symptoms or reduction in frequency of migraine episodes?

Search Terms: Hyperbaric oxygenation, headache.

The Study:

Double-blinded concealed randomised crossover trial with intention-to-treat.

Females with a confirmed diagnosis of migraine headaches for at least 5 years and who were suffering a typical migraine attack at the time of study.

Control group (N = 8;8 analysed): Withdrawal of prescription pain medication for 6 hours prior to sham treatment on 100% oxygen at 1ATA for 60 minutes. Pressure changes of 0.1ATA to mimic treatment.

Experimental group (N =8;8 analysed):  As above but 100% oxygen at 2.4ATA for 60 minutes.

The Evidence:

Outcome             Time to outcome       Control group       Experimental group

Change in visual        60 mins           0.2 (6.5-6.3)          4.4 (7.9-3.5)

analog pain scale                            P=0.99                 P=0.03

(0-10)

Change in manual        60 mins         16.25 (25.75-9.5)       7 (19.33-12.33)

palpation tenderness                         P=0.02                 P=0.03

Dolorimeter             60 mins         8.03 (42.38-34.35)    7.19 (45.07-37.88)

tolerance                                    P=0.90                 P=0.87

Comments:

1. Crossover design with second treatment at 60 to 90 days.

2. No direct comparison between groups was made and baseline VAS scores were different (6.5 v 7.9).

3. No power given, but 8 subjects only.

4. Clinical significance remains unclear.

Expiry date:  November 2003

References:

1. Wilson JR, Foresman BH, Gamber RG, Wright T. Hyperbaric oxygen in the treatment of migraine with aura. Headache 1998;38:112-115.