Wilson
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.
