Eftedal
Hyperbaric oxygenation did not exert a prophylactic effect on migraine
| Clinical bottom line 1. HBOT did not significantly decrease hours of migraine headache in the 8 weeks following treatment. 2. No apparent effect on a marker of vasoconstriction (endothelin-1). Significance unknown. |
Citation/s: 1. Eftedal OS, Lydersen S, Helde G, White L, Brubakk AO, Stovner LJ. A randomised, double-blind study of the prophylactic effect of hyperbaric oxygen therapy on migraine. Cephalalgia 2004; 24:639-644 Lead author's name and fax: Lars Stovner: [| lars.stovner@medisin.ntnu.no]
Three-part Clinical Question: In migraneurs, does the addition of prophylactic hyperbaric oxygenation to usual therapy reduce time spent with headache? Search Terms: migraine, endothelin
The Study:Double-blinded concealed randomised controlled trial without intention-to-treat. The Study Patients: Migraneurs with 2 to 8 attacks each month for three months prior to enrolment. Control group (N = 20; 15 analysed): Air breathing at 2 ATA for 30 minutes daily for 3 days. Experimental group (N = 20; 19 analysed): As above but 100% oxygen breathing
The Evidence:
| Measure | Control Group | HBOT Group | Difference | 95% CI | ||
| ^ | Mean | SD | Mean | SD | ^ | ^ |
| Change in headache, before versus after therapy (week one, hrs) |
-0.6 | -4.0 | 3.4 | |||
| Change in headache before versus 8 weeks after therapy (hrs) |
-5.0 | +4.4 | -9.4 | |||
| Endothelin-1 plasma levels after 3 treatments (pg/ml) |
0.81 | 0.27 | 0.75 | 0.13 | 0.06 | -0.08 to 0.20 |
| Outcome | Time to Outcome | Control Rate | HBOT rate | Relative risk reduction | Absolute risk reduction | Number needed to treat |
| Acute headache resolution during therapy | During therapy | 0.36 | 0.42 | 9% | 0.06 | 17 |
| ^ | 95% Confidence Intervals: | -49% to 68% | -0.32 to 0.44 | NNT 2 to INF; NNH 3 to INF |
Comments: 1. Small study, no power or sample size calculation. 2. Unusual hyperbaric regimen and above normal inspired oxygen tension in control group. 3. Results given do not allow full evaluation and some values are read from a graph 4. An analysis investigating the duration of any possible treatment effect for HBOT did not suggest any significant benefits. Validity unknown. 5. No treatment sparing effect noted (no results given).
Appraised by: Sean Hopson and Mike Bennett, Prince of Wales Hospital, Sydney ; Friday, 8 September 2006Email: [| sean@thegasman.org] Kill or Update By: September 2015
