Oxygen
Schmerz. 2007 Sep 22 [Epub ahead of print]Hyper- or normobaric oxygen therapy to treat migraine and cluster headache pain : Cochrane Review.
[Article in German]
Schnabel A, Bennet M, Schuster F, Roewer N, Kranke P.
Klinik und Poliklinik für Anästhesiologie und operative
Intensivmedizin, Universitätsklinikum Münster, Münster,
Deutschland.
BACKGROUND: The aim of this systematic review was to assess the benefits and harms of supplemental oxygen (HBOT/NBOT) for treating and preventing migraine and cluster headaches
.
MATERIAL AND METHODS: All randomized trials comparing the effect of supplemental oxygen on migraine or cluster headache with those that exclude supplemental oxygen were included in this review. The systematic search included all relevant sources according to the paradigms of the Cochrane Collaboration. Data were analyzed with RevMan 4.2.
RESULTS: Nine trials involving 201 participants satisfied the inclusion criteria. HBOT was effective in relieving an acute migraine and seemed to be sufficient in the treatment of an acute cluster attack. NBOT was effective in terminating acute cluster headache compared to sham treatment, but not in comparison to sublingual ergotamine. There was no evidence for any prophylactic effects. Serious adverse effects were not noted in the trials investigated.
CONCLUSIONS: There is some evidence that HBOT is effective for termination of acute migraine. NBOT was similarly effective in cluster headache, however with sparse data. Because of costs and poor availability HBOT cannot be regarded as a routine therapy. Further indications in the case of treatment failure using standard therapy need to be defined based on data of future clinical trials.
PMID: 17885769
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The Journal of headache and pain, Volume 3, Number 1 / April, 2002, pp. 33-36
Cold room air inhalation to abort cluster headaches: an exploratory study
Martha Sue McLeod, Frank Andrasik, Russel C. Packard, Bayard D. Miller
Research has shown that inhalation of pure oxygen is effective in aborting
cluster headache. This article advances the hypothesis that cooling is the
critical ingredient behind the effectiveness of oxygen inhalation, rather than
the oxygen concentration. To test this hypothesis, eight cluster headache
participants used a device that delivered cooled room air as a means to abort
headache attacks. Additionally, six of the subjects administered pure oxygen so
that comparisons could be made to the air-cooling device. The proportion of
cases in which subjects attained effective relief from cluster headache pain by
use of the air-cooling device was significantly higher than the proportion of
cases in which subjects did not attain effective relief from headache pain.
There was no significant difference between the proportion of headaches relieved
by oxygen and the proportion of headaches relieved by the air-cooling device.
This study raises questions about the mechanisms of action of oxygen inhalation
for treating cluster headache, and indicates that future clinical investigations
into the use of cold room air for treating cluster headache pain are warranted.
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Headache 1998;38:378.
Historical Development Of Normobaric Oxygen In The Symptomatic Treatment Of Cluster Headache
DJ Capobianco Jacksonville, FL
Objective: - Review the historical development of normobaric oxygen in the acute treatment of cluster headache.
Background: - The use of normobaric oxygen in the treatment of headache
can be traced back to Drs. Boothby, Alvarez, and Horton of the Mayo
Clinic.
Method: - Review of published papers.
Results: - In 1938, under the direction of Walter M. Boothby, MD,
oxygen therapy was employed in the symptomatic treatment of headache.
Alvarez reported the beneficial response of 100% oxygen, delivered at a
flow rate of between 6 to 8 liters per minute, as abortive treatment
for headache [1]. Unfortunately, it is difficult to know if this
included patients with cluster headache. Bayard T. Horton was the first
to note that inhaling 100% oxygen alleviated a cluster attack, if taken
during the initial headache phase [2]. Friedman and Mikropoulos [3] and
later, Graham [4], also noted this beneficial response of oxygen
inhalation for cluster headache. In 1978, an optometrist, Jerold F.
Janks, published his own personal account of oxygen's beneficial role
in the treatment of cluster headache [5]. Kudrow elaborated further on
Horton's finding. He noted that 75% of outpatients treated with 100%
oxygen administered via face mask at 7 liters per minute, experienced
complete or near complete relief within 15 minutes [6]. Anthony found
that oxygen inhalation was beneficial in all 12 patients studied [7].
Fogan, in the only double-blind control study, demonstrated that oxygen
inhalation provided complete or substantial relief in at least 80% of
patients' cluster attacks [8].
References:
[1] Alvarez WC, Mason AY. Results obtained in the treatment of headache with the inhalation of pure oxygen. Mayo Clin Proc. 1940;15:616-618.
[2] Horton BT. Histaminic cephalgia. Lancet. 1952;72:92-98.
[3] Friedman AP, Mikropoulos HE. Cluster headaches. Neurology. 1958;8:653-663.
[4] Graham JR. Cluster headache. In: Appenzeller O, ed. Pathogenesis and Treatment of Headaches. New York: Spectrum Publications; 1976:93-108.
[5] Janks JF. Oxygen for cluster headaches. JAMA. 1978;239:191.
[6] Kudrow L. Response of cluster headache attacks to oxygen inhalation. Headache. 1981;21:1-4.
[7] Anthony M. Treatment of attacks of cluster headache with oxygen inhalation. Clin Exp Neurol. 1981;18:195.
[8] Fogan L. Treatment of cluster headache. A double-blind comparison of oxygen vs air inhalation. Arch Neurol. 1985;42:362-363.
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Headache. 1990 Oct;30(10):656-9.
Cluster headache: the effect of low oxygen saturation.
Zhao JM, Schaanning J, Sjaastad O.
Department of Neurology, University Hospital, Trondheim, Norway.
The present study concerns the possible relationship between hypoxia and the generation of cluster headache attacks. Fifteen controls and 25 cluster headache patients were studied. The patients were allocated into two groups according to cluster headache stage, i.e. cluster or remission period. During the tests, all the subjects were asked to inhale 12% oxygen (88% N2) for 30 min, and the decreasing oxygen saturation (SaO2%) was monitored. Patients in the remission period showed nearly the same decrement of SaO2% as controls. At the end of the test, patients in the bout showed significantly less reduction of SaO2% than the controls. In 5 patients, the test was carried out both in and outside the cluster periods. The tendency to less decrement in oxygen saturation in the cluster phase was as marked with this comparison, but the difference between the groups was not significant, probably partly due to the low number of tests carried out. Only one patient got a typical attack. It seems that hypoxia of this magnitude per se is not the cause of attacks. The different pattern with respect to SaO2% following 12% O2 inhalation in cluster headache may be due to an abnormality in central regulation and/or chemoreceptor sensitivity.
PMID: 2272817
______
Nervenarzt. 1986
May;57(5):311-3.
Cluster headache and chronic paroxysmal hemicrania--effectiveness of oxygen inhalation.
Heckl RW
Ten patients suffering from cluster headache or variants of cluster headache
were made to inhale oxygen in an attempt to check these attacks. This treatment
proved a success with six patients with classic ("episodic") cluster
headache, as well as with another patient suffering from secondary chronic
cluster headache. One patient with primary chronic cluster headache and another
with chronic paroxysmal hemicrania (PCH) experienced only temporary relief and a
female patient with PHC showed no reaction to oxygen inhalation. The patient who
suffered from secondary chronic cluster headache has had no further attacks in
the four years following this treatment.
PMID: 3724924
______
Arch Neurol.
1985 Apr;42(4):362-3.
Treatment of cluster headache. A double-blind comparison of oxygen v air inhalation.
Fogan L
Nineteen men, aged 20 to 50 years, were treated in a double-blind crossover
study comparing oxygen v air inhalation at 6 L/min via nonrebreathing face masks
for 15 minutes or less, for up to six headaches. Patients scored their own
degree of relief for each treatment as none, slight, substantial, or complete
relief. The average (+/- SE) relief score for all oxygen-treated patients was
1.93 +/- 0.22 out of a possible total score of 3.0, and for air the treatment
relief score was 0.77 +/- 0.23. This difference is highly statistically
significant by an analysis-of-variance F test; it documents that patients with
cluster headache can benefit from oxygen inhalation during acute attacks.
PMID: 3885921
______
Headache Volume 21 Issue 1 Page 1-4, January 1981
Response of Cluster Headache Attacks to Oxygen Inhalation
Kudrow, L.
California Medical Clinic for Headache, 16542 Ventura Boulevard, Encino,
California. (213) 986-4248.
SYNOPSIS
Fifty-two randomly selected patients diagnosed as having either
active episodic or chronic cluster headaches were evaluated for symptomatic
response to oxygen inhalation. At the onset of attacks, 100% oxygen was
administered through a facial mask at a rate of 7 liters per minute, for 15
minutes. Each patient self-treated ten attacks, and timed the rated reduction of
pain. A successful treatment result required complete or almost complete
reduction of pain in seven of ten attacks, within 15 minutes. In a second
(crossover) trial involving an additional 50 patients, sublingual ergotamine
tartrate (ErgomarÒ) was compared to oxygen inhalation for symptomatic relief of
cluster attacks. Each patient treated ten attacks with either preparation in
accordance with the crossover design. Oxygen was administered as described
above. Sublingual ergotamine was used every five minutes, to a maximum of three
tablets, if necessary. In the first trial 3952 (75%) of patients obtained
significant relief from cluster pain. The greatest benefit (92.9%) was found
among episodic patients under 50 years of age. The least benefit (57%), was
found among chronic patients over 49 years of age. In the second trial, results
among oxygen users were better (82%) than those of ergotamine users (70%), but
not significantly. Rapidity of relief was similar in both groups. The results of
both series indicate that oxygen inhalation is an efficacious symptomatic
treatment for cluster attacks. It is superior to ergotamine since there are
neither complications nor contraindications to its use. Ergotamine, however, has
the advantage of convenience.
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1526-4610.1981.hed2101001.x?journalCode=hed
______
A post by Ted Marcus from the message board at CH.com about how he got his
insurance company to approve oxygen therapy:
When I was initially rejected by my insurance co for O2 I immediately
called and spoke to my case manager at the insurance company (rather
than waiting for them to send me paperwork and me send it back and them
getting around to reading it and doing some sort of appeal without the
benefit of my input or pushing things to get done. It's important to
both be professional when talking to the case manager, but more
important to charm them so they'll want to speed things up for you.)
and she explained that when she talks to the company's doctor about my
case she would need to show him abstracts (they have a lot of cases to
go through and don't have time for reading many full articles on the
subject) from reputable sources showing that O2 very well IS an
effective treatment in aborting attacks. So I compiled a bunch of
article summaries on the subject, faxed it to her and within a week of
initial rejection had my oxygen once again. Here is what I sent:
|
Cephalalgia.
1995 Oct;15 Suppl 15:33-6. Department of Neurology, Soder Hospital, Stockholm, Sweden. The spontaneous capricious course of cluster headache
may give rise to some problems when treatment is being evaluated. This
is one of several explanations for there being so few well-designed,
randomized, double-blind clinical trials in cluster headache. The
standard treatment of acute attacks of cluster headache is inhalation
of 100% oxygen. In the prophylaxis of episodic cluster headache,
ergotamine, verapamil, lithium, serotonin, inhibitors and steroids are
used. In chronic cluster, lithium is the drug of choice, but verapamil
may also be tried. Recently, hyperbaric oxygen has been shown to
immediately abort acute attacks, and it seems that it may also be
useful in the prophylactic treatment. The introduction of the novel
5HT1 agonist sumatriptan as a symptomatic relief of cluster attacks
represents further significant progress. Two randomized, double-blind,
placebo-controlled, cross-over trials have shown sumatriptan 6 mg sc to
be a rapid, effective and well-tolerated acute treatment for cluster
headache attacks. Within 15 min of treatment, 74% of attacks on
sumatriptan responded compared to 26% of placebo-treated attacks.
Functional disability was also significantly improved. Increasing the
dose to 12 mg did not offer significantly greater relief compared to
sumatriptan 6 mg, but was associated with an increased incidence of
adverse events. Interim analysis of 3 months of data from a recent
multinational open trial comprising, 138 patients having treated 6353
attacks with subcutaneous sumatriptan 6 mg revealed a headache relief
in 96% of attacks treated. There was no evidence of an increased
incidence of adverse events with frequent use of sumatriptan. No
tachyphylaxis was seen over the 3 months, suggesting that sumatriptan
is effective and well tolerated also in long-term acute treatment for
cluster headache. |
| J
Pain Symptom Manage. 1993 Apr;8(3):155-64.
Diagnosis and treatment of cluster headache. Campbell JK Cluster headache (CH) is a rare form of headache occurring in both episodic and chronic forms. The painful attacks are short-lived, occur unilaterally, and are associated with signs and symptoms of autonomic involvement. Attacks frequently occur at night and can be precipitated by ingestion of alcohol. In the episodic form, attacks occur daily for some weeks followed by a period of remission. In the chronic form, attacks can continue for years. Inheritance is not a factor in CH. Treatment can be symptomatic or prophylactic. Agents used to treat individual attacks include inhalation of oxygen, rapidly acting forms of ergotamine and dihydroergotamine, and sumatriptan. Prophylactic treatment employs calcium-channel-blocking agents, methysergide, lithium, and corticosteroids. Surgical modalities, notably thermocoagulation of the gasserian ganglion, can provide relief in those who are resistant to medical management. PMID: 8326166 |
| Headache.
1996 Feb;36(2):105-7.
Analgesic use in cluster headache. Gallagher RM, Mueller L, Ciervo CA
University Headache Center, University of Medicine & Dentistry of New Jersey, Cluster
headache is a brutal affliction characterized by excruciating pain with
relatively brief, but frequent attacks. Because of the short duration
of the attacks and the tremendous intensity of pain, symptomatic
analgesics are often not effective. However, inhalation oxygen, while
being cumbersome, is reported to be effective in the majority of
sufferers. To assess the practical effectiveness and use of analgesics
and/or oxygen, a review of 60 cluster patients was conducted. At
initial evaluation, 48 patients had accepted oral analgesics and 51
patients accepted inhalation oxygen for breakthrough headaches. After
acceptable prophylactic treatment was established, 65% of patients who
accepted analgesics continued their use, although most reported only
minimal relief. Only 31% of patients who accepted oxygen continued its
use, in spite of the fact that most sufferers reported significant
relief. From this brief study, it appears that cluster headache
patients prefer to use analgesics for reasons that are not solely for
relief of pain, and that patients decline the use of oxygen for reasons
other than lack of effectiveness. |
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