Neurological

High flow transnasal dehumidified air can relieve acute migraine headaches

According to a study published in Cephalalgia, high-gas nasal dry gas therapy (air or oxygen) can help relieve pain associated with migraines.

Previous research has shown that the cooling effects of high flow, dry oxygen result in pain relief for patients. A previous study in which a mixture of pressurized perfluorocarbons (PFC) and air was delivered to patients via an intranasal catheter significantly reduced headaches. Therefore, the study researchers attempted to evaluate the role of cooling and oxygen therapy in relieving the pain associated with acute migraine headaches.

In this study (ClinicalTrials.gov: NCT04129567) 3 different treatment arms were compared with 1 control arm. Patients suffering from an acute headache episode were recruited if they were diagnosed with migraine (> 1 year), had their first migraine episode before the age of 50, had at least 1 migraine attack per month and had no changes in had had their migraine prophylaxis medication for at least 3 months prior to enrollment and met the criteria of the International Classification of Headache Disorders (ICHD-3) for episodic migraines. The patients did not take their migraine medication until the end of the study.

Baseline patient characteristics and Migraine Disability Assessment Scale (MIDAS) scores were recorded. The 51 participating patients had an average MIDAS value of 69.2 (standard deviation ± 46.2).

The patients remained seated and randomly received dry oxygen (12), dry air (11), humidified oxygen (20) or humidified air therapy (8, control) via a soft nasal cannula at 15 liters / minute for 15 minutes. Patients who were self-reported via VAS questionnaires (Visual Analog Scale) survey symptoms of pain (headache), nausea, sensitivity to light and sensitivity to noise (sensitivity to noise) on a scale of 1 to 10 at the start of the study, 5 minutes, 15 minutes, 2 hours and 24 hours.

Patients who received humidified oxygen, dry air and dry oxygen showed a significant reduction in pain scores from baseline to 2 hours after therapy compared to the control arm (5.5 ± 2.1 to 3.1 ± 1.9, 4, 4 ± 2.1 to 2.6 ± 2.5 and 4.7) ± 2.2 to 3.0 ± 2.3; P <0.05 for all comparisons). The mean pain scores were significantly reduced in patients treated with humidified oxygen and dry air after 24 hours (5.5 ± 2.1 to 4.4 ± 2.3 and 4.4 ± 2.1 to 3, respectively, 2 ± 2.2; P <0.05 for both comparisons). After 2 hours, 46% of the patients in the dry air group, 25% of the patients in the dry oxygen group, and 20% in the humidified oxygen group were pain relief.

The mean nausea value was reduced after 2 hours in the arm with dry oxygen compared to the control arm (-1.5) [95% CI -2.7, -.2]). More than 70% of the patients in the treatment groups experienced nausea relief, while only 25% in the control group experienced this relief.

All therapies resulted in a significantly greater reduction in the 2-hour photosensitivity values ​​compared to controls. The presence of oxygen and dryness were independently associated with reductions in pain and light sensitivity scores.

Limitations of the study included the small sample size and the potential for bias experienced by the experimenters due to their simply blinded nature. There was also a bug in the randomization process that resulted in unequal allocation ratios between the groups.

Ultimately, the study’s researchers concluded that “transnasal dry gas (air or oxygen) at a flow rate of 15 l / min is safe and feasible and may be an effective intervention in the acute treatment of migraines.”

Disclosure: One of the researchers involved in the conception and design of the study is a co-founder of CoolTech LLC, which is developing a nasal cooling device for the treatment of cardiac arrest and neurogenic fever outside of the hospital setting.

reference

Shah R., Assis F., Narasimhan B. et al. High flow transnasal dehumidified air for acute migraine headaches: a randomized controlled trial. Cephalalgia. Published online February 25, 2021. doi: 10.1177 / 0333102421997766

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