Trans-Nasal High-Flow Dehumidified Air May Reduce Acute Migraine Headache Pain

Trans-nasal high-flow dry gas (air or oxygen) therapy may help reduce migraine associated pain, according to a study published in Cephalalgia.

Past research has suggested that the cooling effect of high-flow dry oxygen leads to pain relief for patients. A previous study in which a pressured perfluorocarbons (PFC)/air mixture was delivered to patients via intranasal catheter was found to significantly reduce headaches. Thus, study researchers sought to assess the role of cooling and oxygen therapy in alleviating the pain of acute migraine headaches.

This study (ClinicalTrials.gov: NCT04129567) compared 3 different treatment arms to 1 control arm. Patients suffering from an acute headache episode were recruited if they were diagnosed with migraine (>1 year), suffered their first migraine episode before 50 years of age, had at least 1 migraine attack per month, had no changes in their migraine prophylaxis medications for at least 3 months prior to enrollment, and met the International Classification of Headache Disorders (ICHD-3) criteria for episodic migraine. Patients did not take their migraine medications 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 score of 69.2 (standard deviation, ±46.2).

Patients remained seated and were randomly administered 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 self-reported via Visual Analog Scale (VAS) questionnaires symptoms of pain (headache), nausea, light sensitivity, and sound (noise) sensitivity on a scale of 1 to 10 at baseline, 5 minutes, 15 minutes, 2 hours, and 24 hours.

Patients receiving humidified oxygen, dry air, and dry oxygen showed a significant reduction in pain scores from baseline to 2 hours post-therapy compared with 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, respectively; P <0.05 for all comparisons). Mean pain scores were significantly reduced in patients treated with humidified oxygen and dry air at 24 hours (5.5±2.1 to 4.4±2.3 and 4.4±2.1 to 3.2±2.2, respectively; P <0.05 for both comparisons). At 2 hours, 46% of patients in the dry air group, 25% of patients in the dry oxygen group, and 20% in the humidified oxygen group were relieved of pain.

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

All therapies led to significantly greater reduction in 2-hour photosensitivity scores compared with controls. The presence of oxygen and dryness were independently associated with reductions in pain and photosensitivity scores.

Limitations of the study included its small sample size and possible experimenter bias due to its single-blinded nature. There was also an error in the randomization procedure which resulted in unequal allocation ratios between the groups.

Ultimately, the study researchers concluded that, “Trans-nasal dry gas (air or oxygen) at a flow rate of 15 L/min is safe, feasible, and may be a potentially effective intervention in the acute treatment of migraine.”  

Disclosure: One of the researchers, who was involved in the concept and design of the study, is the co-founder of CoolTech LLC, which is developing a trans-nasal cooling device for use in out-of-hospital cardiac arrest and neurogenic fevers.

Reference

Shah R, Assis F, Narasimhan B, et al. Trans-nasal high-flow dehumidified air in acute migraine headaches: a randomized controlled trial. Cephalalgia. Published online February 25, 2021. doi:10.1177/0333102421997766