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2012-02-17T01:45:47Z

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'''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 2015
'''References:''' 
1. Wilson JR, Foresman BH, Gamber RG, Wright T. Hyperbaric oxygen in the treatment of migraine with aura. Headache 1998;38:112-115.

[[File:http://www.hboevidence.com/_themes/copy-of-sumi-painting/sumhorsa.gif|center|external]]

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