Role of Hyperbaric Oxygen Therapy in Migraine
What is Migraine?
Usually characterized by throbbing pain on the one side of the forehead, a migraine is a moderate to severe headache. Strong headaches associated with nausea, vomiting, and light sensitivity are known as migraines. Additionally, a lot of people experience symptoms like feeling or being unwell, as well as increased sensitivity to light or sound. Around one in five women & one in fifteen men suffer from migraines, making it a widespread medical disease. Early adulthood is typically when they start. Migraine discomfort is commonly described as:
- pulsating
- throbbing
- perforating
- pounding
- debilitating
It can also be painful and feel dull and constant. The pain could at first be minor. But if left untreated, it can worsen from mild to severe. The forehead region is most frequently affected by migraine pain. It often affects one side of the head, although it can also move or affect the other side [1].
Types
There are various migraine subtypes, including:
1. Migraine with aura: When warning symptoms, such as seeing flashing lights, appear soon before the migraine starts.
2. The most frequent type of migraine is one without an aura, in which there are no distinct warning symptoms. When a migraine aura or other migraine symptoms are present, but a headache does not materialize, this condition is referred to as silent migraine. Some people can get migraines up to several times per week. Others only occasionally experience migraines [2].
Treatment
Although there is no known cure for migraines, there are several therapies that might help lessen the symptoms.
These consist of:
medications that can help in reverse the changes in the brain that may induce migraines, such as painkillers, including over-the-counter medications like paracetamol and ibuprofen triptans.
Anti-emetics are drugs that are frequently used to aid patients who are feeling queasy or ill (nausea).
Many people discover that lying down or napping during an attack might be beneficial.
Symptoms
Everybody has a different migraine. They often take place in phases in numerous persons. These phases could involve:
1. Prodrome
About 60% of migraine sufferers have symptoms: hours or days before a headache.
- being delicate to scent, sound, or light
- Fatigue
- yearning for food or a lack of appetite
- Mood shifts
- extreme thirst
- Bloating
- diarrhea
2. Aura
Your neurological system is the source of these symptoms, which frequently affect your vision. They often begin gradually, last between five and twenty minutes, and are shorter than an hour. You could:
- See wavy lines, flashes of light, black spots, or objects that are not there (hallucinations)
- have a narrow focus
- to be completely blind
- One side of your body is tingling or numb.
- inability to talk clearly
- Feeling heavy in the arms and legs
- experience ringing in the ears
- Observe alterations in your senses of taste, smell, or touch.
3. Attack
A migraine headache frequently starts as a throbbing sensation before becoming dull. Usually, it gets worse as you exercise. The pain may be in the front of your head, travel from one side to the other side of your head feel as though it is pervasive throughout your brain. A headache and nausea are experienced by 80% of persons, and about half of them vomit. Additionally, you can feel dizzy or cold and pale [3].
4. Postdrome
After a headache, this phase can linger for up to a day. These signs include:
- feeling worn out, drained, or irritable
- Being unusually energized or content
- aching or weakened muscles
- yearning for food or a lack of appetite
Causes
Migraine is a disorder that causes headaches. Although migraine headaches appear to be linked to genetics and changes in your brain, doctors are unsure of their specific etiology. Even migraine causes like exhaustion, harsh lights, or changes in the weather can be inherited from your parents. For a long time, scientists believed that alterations in the blood flow to the brain were the cause of migraines. Most people now believe that while it may contribute to discomfort, it does not cause it. According to current theories, your trigeminal nerve, which supplies sensation to your head and face, is what triggers an attack of migraine headaches. This signals the release of hormones like serotonin and calcitonin gene-related peptides by your body (CGRP). The brain’s lining blood vessels enlarge when CGRP is present. Neurotransmitters then contribute to pain and inflammation [4].
Migraine Triggers
Numerous factors might cause migraines, such as:
- female hormonal changes: Many women experience headaches when their estrogen levels fluctuate, such as before or during menstrual periods, during pregnancy, or throughout menopause.
- Oral contraceptives are one example of a hormonal medicine that can make migraines worse. However, some women find that using these medications reduces the frequency of their migraine attacks.
- Drinks: A lot of alcohol, especially wine, and coffee, which are high in caffeine, are examples of these.
- Stress: Migraines may be triggered by stress at work or home.
- sensory arousal: Loud noises and bright or flashing lights can also cause migraines. Some people experience migraines when they are exposed to strong scents like perfume, paint thinner, secondhand smoke, and others.
- Sleep modifies: For certain people, sleep deprivation or excessive sleep can cause migraines.
- physical elements: Migraines may be brought on by vigorous physical activity, including sexual activity.
- The weather shifts: A migraine may be brought on by a change in the weather or barometric pressure.
- Medications: Vasodilators like nitroglycerin and oral contraceptives can make migraines worse.
- Foods: Migraines may be brought on by aged cheeses, salty meals, and processed foods. As well as missing meals.
Treatment
Acute medicines, which should be taken as soon as you anticipate a migraine attack, include:
- NSAIDs: Ibuprofen and aspirin are examples of NSAIDs that are frequently taken during mild-to-moderate bouts that do not involve nausea or vomiting.
- Triptans: These drugs, such as sumatriptan, El triptan, and rizatriptan, are frequently the first line of treatment for people whose migraine attacks include nerve pain.
- Antiemetics: Metoclopramide, chlorpromazine, and prochlorperazine are examples of antiemetics that are frequently used with NSAIDs to lessen nausea.
- Ergot alkaloids: These drugs, such as Migranal and Ergomar, are rarely recommended and are often saved for those who do not react well to triptans or analgesics.
- Antihypertensives: These medications are used to treat high blood pressure and migraines. Examples of hypertension medications used to prevent migraines include beta-blockers and candesartan, which block the angiotensin receptor.
- Anticonvulsants: A few anti-seizure drugs may also be able to stop migraines in their tracks.
- Antidepressants: Amitriptyline and venlafaxine are two antidepressants that may also be able to stop migraine attacks.
- Botox: Botox injections are given to the head and neck muscles every three months.
- Calcitonin gene-related peptide therapies: These therapies function to stop the onset of a migraine attack and are given intravenously or through injection [5].
Hyperbaric Oxygen as Effective Medicine for Migraine
How does HBOT work?
Hyperbaric oxygen treatment increases the amount of oxygen in the blood and tissues by applying high pressure. This treatment involves being exposed to pure oxygen concentrations at high atmospheric pressures, which may be greater than or equivalent to 1.4 atmospheres. While confined in an area with a minimum pressure of 2 ATA (above ambient atmospheric pressure), patients must only breathe oxygen for all approved purposes of UHMS-approved hyperbaric medicine. For this, there needs to be a pressure environment that is greater than air pressure at sea level; this chamber can have flexible or rigid forms and mechanisms for delivering 100 percent oxygen for treatment. A predetermined plan is followed by trained professionals who keep an eye on patients and change schedules as needed.
Without the use of prescription medications, hyperbaric oxygen therapy for migraines seeks to lessen or eliminate symptoms and reduce the frequency at which they occur.
HBOT gives patients pure oxygen at a higher pressure and was first mentioned as a headache and migraine treatment option in 1939, according to the nonprofit National Headache Foundation. As a result, blood plasma can carry significantly more oxygen, which increases the quantity of O2 that can reach various parts of the body, including the brain. That extra oxygen could restore blood flow to brain tissue, as well as lessen swelling and blood vessel spasms if done in a controlled-setting under the supervision of a trained specialist [6].
Early on, oxygen inhalation was recommended as a migraine headache remedy. Recent research has shown that the treatment of cluster headaches involves the use of hyperbaric oxygen, which can significantly increase blood oxygenation compared to normobaric oxygen. Twenty migraine sufferers were split into two groups at random and observed in a hyperbaric chamber throughout an average headache attack. A verbal descriptor scale was used to measure the severity of generalized headaches both before and after exposure to oxygen. While the other received 100% oxygen at 2 atmospheres of pressure, one group was given 100% oxygen at 1 atmosphere of pressure (normobaric) (hyperbaric). In the hyperbaric group, 9 out of 10 patients experienced significant relief from headache symptoms, compared to 1 out of 10 patients in the normobaric group [7].
A 40-year-old man arrived at the authors’ hospital complaining of an excruciating, ongoing, and throbbing headache on the right side. Occasionally, photophobia occurred, although there were no visual problems. Oral painkillers were ineffective. He was recommended to get 20 sessions of 90-minute HBOT at 2 atmospheres absolute after rigorous review (ATA). It was intended to deliver one session per day, five days a week, for a total of four weeks. The patient reported improved symptoms after the 20 sessions and did not need any oral medicine. According to the authors, more research should be done on hyperbaric oxygen therapy as a treatment for pharmacologically resistant migraine.
Numerous research on the use of HBOT to treat migraines has been reported. A similar case report recently demonstrated the successful management of migraine in a patient who was 23 years old. 18 For 40 sessions, the authors administered a 1.5 ATA therapy in a chamber. As opposed to the 40 sessions that were documented, the authors only had 20 sessions with the patient, which will cut the treatment time by 50%. The 20-session intervention approach has the additional benefit of causing the patient’s routine and productivity less interruption and yielding results more quickly. Despite having a higher ATA, the patient was content and uncomplaining [8].
With no other pertinent medical history, we present a 23-year-old female with a self-reported history of aura-accompanied headaches dating back to the age of 12. She reported her headaches as being severe, lasting 4-6 hours, and happening on average three times per month. The patient had treatment in a hyperbaric chamber Monday through Friday for one hour each, for a total of 40 sessions, though they admitted to skipping a few courses during the eight weeks. The patient did not receive any other migraine therapies throughout this time, and no more than one session a week was skipped. By the time she received her 24th treatment, the patient had only ever had one migraine with an aura but no incapacitating pain. Before beginning hyperbaric treatment, the patient claimed she had never experienced a migraine with such a low level of intensity. She also reported that she did not need to miss any days of work or school while receiving treatment. She was found to be extremely satisfied and had only had one moderate migraine attack over the entire length of her 40-day treatment session upon follow-up. It is crucial to note that the patient underwent HBO treatments only once and did not receive any extra therapy [9].
References
1. Natoli JL, Manack A, Dean B, Butler Q, Turkel CC, Stovner L, et al. Global prevalence of chronic migraine: a systematic review. Cephalalgia. (2010) 30:599–609. doi: 10.1111/j.1468-2982.2009. 01941.x
Link: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-2982.2009.01941.x
2. Lipton RB, Silberstein SD. Episodic and chronic migraine headache: breaking down barriers to optimal treatment and prevention. Headache. (2015) 55(Suppl. 2):103–22. doi: 10.1111/head.12505_2
Link: https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.12505_2
3. Charles A. The evolution of a migraine attack – a review of recent evidence. Headache. (2013) 53:413–9. doi: 10.1111/head.12026
Link: https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.12026
4. Bigal ME, Lipton RB. Modifiable risk factors for migraine progression. Headache. (2006) 46:1334–43. doi: 10.1111/j.1526-4610.2006. 00577.x
Link: https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/j.1526-4610.2006.00577.x
5. Goadsby P.J., Holland P.R. An update: pathophysiology of migraine. Neurol Clin [Internet] 2019; 37:651–671.
Link: https://europepmc.org/article/med/31563225
6. Myers, Daniel E., and Roy A. Myers. “A preliminary report on hyperbaric oxygen in the relief of migraine headache.” Headache: The Journal of Head and Face Pain 35.4 (1995): 197-199.
Link: https://headachejournal.onlinelibrary.wiley.com/doi/abs/10.1111/j.1526-4610.1995.hed3504197.x
7. EMJ Neurol. 2021; 10.33590/emjneurol/20-00262. https://doi.org/10.33590/emjneurol/20-00262.
8. Matera DV et al. Revisiting the expanded use of hyperbaric oxygen therapy for treatment of resistant migraines. Med Gas Res. 2019;9(4):238-40.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802418/
9. Matera DV, Smith B, Lam B. Revisiting the expanded use of hyperbaric oxygen therapy for treatment of resistant migraines. Med Gas Res. 2019 Oct-Dec;9(4):238-240. doi: 10.4103/2045-9912.273963. PMID: 31898611; PMCID: PMC7802418.
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802418/
