Nilsson
Hyperbaric oxygenation did not improve duration or intensity of headache in patients with established cluster headache.
| Clinical bottom line: 1. No evidence that HBO improves outcome in cluster headache compared to a sham therapy. |
Citation/s:1. AIM. Nilsson Remahl, R. Ansjon, F. Lind, E. Waldenlind. Hyperbaric oxygen treatment of active cluster headache: a double-blind placebo-controlled cross-over study. Cephalalgia 2002; 22:730-739. Lead author's fax: +46 8774 48 22 Three-part Clinical Question: For patients with cluster headache does the application of HBO, compared to a standard treatment with normobaric oxygen during a cluster, result in prevention or shortening of headache clusters? Search Terms: cluster headache. The Study:Double-blinded randomised cross-over trial with intention-to-treat. The Study Patients: Patients with chronic or episodic CH, with at least six headaches during the week prior to enrolment, and an expected remaining CH period of > 4 weeks. Excluded if using prophylactic treatment. Control group (N = 12; 12 analysed): Sham treatment using 10% oxygen for 70 minutes at 2.5 ATA for two sessions 24 hours apart. Rescue simple analgesia if required. Experimental group (N = 10; 10 analysed): HBO treatment with 100% oxygen as above. The Evidence:
| Outcome | Time to Outcome | Sham rate | HBO rate | Relative risk reduction | Absolute risk reduction | NNT |
| >50% reduction in HI. | 1 week | 0.38 | 0.36 | -5% | -0.02 | 56 |
| ^ | 95% Confidence Intervals: | -97% to 87% | -0.36 to 0.33 | NNT 3 to INFNNH 3 to INF |
Comments: 1. Small study with low power to detect important differences between groups. 2. Patients were divided into chronic and episodic groups after primary analysis. 3. 2 patients had remission of headaches for >1 year after sham treatment and were therefore not crossed over. 4. 5 patients required mild to moderate attacks during sham treatment, none during HBO. 5. Authors measured a number of serum markers of vasoactivation, but reported no significant differences. 6. Results poorly reported with apparent 'post-hoc' comparisons.
Appraised by: Jetske van Breda and Mike Bennett, Prince of Wales Hospital; Monday, December 15, 2003Email: [| Jetskevanbreda@hotmail.com] Kill or Update By: December 2015
