HBOT: a therapeutic approach to migraines

Migraine and cluster headaches are severe and disabling. Migraine affects up to 18% of women, while cluster headaches are much less common (0.2% of the population). A number of acute and prophylactic therapies are available. Hyperbaric oxygen therapy (HBOT) is the therapeutic administration of 100% oxygen at environmental pressures greater than one atmosphere.

Migraine and cluster headache are disabling health problems among adults and migraine has been identified as a leading contributor to years lived with disability in an analysis for the Global Bur-den of Disease Study 2010. Both types of headache are frequently severe and associated with features other than pain. While the diagnosis and classification of headaches can be difficult and complex, migraine and cluster headaches are generally distinguished by the nature of associated symptoms (nausea, vomiting, and photophobia occur commonly with migraine, while cluster headaches are typically accompanied by tearing and nasal congestion), the pattern in which they occur (cluster headaches typically occur daily for up to several weeks before resolving, often for lengthy periods) and their location and character (cluster headaches are per orbital and unilateral, while migraines can be bilateral and are often described as throbbing).

Migraine maybe preceded by an aura-most often a visual disturbance-in some people. Severe headache is common; in a review of studies on the prevalence of severe headache. Smitherman 2013 suggests about 16%of the adult population in the USA will complain of at least one severe headache over a three-month period, most of which are la-belled as ’migraine’ or ’probable migraine’. Surveys from the USA and elsewhere suggest that 6% to 7% of men and 15% to 18% of women experience migraine headaches, while about 0.1 to 0.2%of the population suffer with cluster headache. First-degree relatives of those with cluster headaches are five to 18 times more likely to have such headaches than individuals in the general population.

The mechanisms involved in both types of headache remain incompletely understood and are active areas of research. Migraine is generally seen as a vascular headache that seems to result from a mixture of environmental and genetic factors, while cluster headache is classified among the trigeminal autonomic cephalalgias and probably involves the hypothalamus. Migraine results in significant disability, work loss, and costs to the individual. The social and economic impact of cluster headache is less clear, but data from Germany suggest time lost to work and healthcare costs are substantial.

The traditional view has been that migraine is primarily a vascular event. This view focuses on explaining the pain involved, but more recently migraine is seen as a sensory processing disturbance, primarily of the sub-cortical aminergic sensory modulatory systems. Such a brain-centered explanation helps to explain the symptomatology of migraine beyond the headache and has implications for treatment. Therapy for headache falls into two categories: acute and preventive.

Acute therapy aims at the symptomatic treatment of the head pain and other symptoms associated with an acute attack or cluster. The goal of preventive therapy is to reduce the frequency or intensity of attacks, or both, and thereby improve patient functioning and quality of life. Preventive therapy is especially well-suited to patients with very frequent or severe attacks, significant headache-related disability, or resistance to acute therapy.

While migraine is a common problem, the number of cases unresponsive to accepted therapeutic approaches may be quite small. It is these patients who may benefit from a therapy delivered at a health facility, such as intravenous DHE, parenteral analgesics or antinauseants or, potentially, hyperbaric oxygen therapy (HBOT).

HBOT requires the patient to be subjected to a higher than atmospheric pressure (1 ATM) in a specialised vessel designed for the purpose. Clinically, HBOT has been reported as a successful treatment for headache since at least 1989, and sporadic reports have followed since that time, including some comparative trials.

Benefits of HBOT in patients with migraines and headaches:

Deflates neuronal tissue

Redistributes brain flow

Favors vasoconstriction

Reduces inflammation and edema

Decrease symptoms and episodes

Source

Bennett MH, French C, Schnabel A, Wasiak J, Kranke P, Weibel S (2015); Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache (Review); Cochrane Database of Systematic Reviews.

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