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High-Flow Oxygen for Cluster Headache
A randomized crossover trial finds this treatment effective.
Small placebo-controlled studies of high-flow oxygen in the treatment of cluster headache have suggested significant efficacy, but the treatment's efficacy has not been confirmed in a high-quality trial. Now, researchers have conducted a larger, partially manufacturer-sponsored, randomized, placebo-controlled, crossover trial of home use of high-flow oxygen delivered via mask. The authors randomized 109 adults with episodic or chronic cluster headache, previously naive to oxygen therapy, to treat four headache attacks acutely with either air or 100% oxygen at 12 L/minute using a nonrebreathing mask. The primary endpoint was freedom from pain at 15 minutes. Secondary endpoints were freedom from pain at 30 minutes; pain reduction at 15, 30, 45, and 60 minutes; need for rescue medications starting at 15 minutes; overall response to treatment; overall disability; and effect on associated symptoms.
The primary endpoint was reached significantly more often with oxygen (78% of attacks) than with air (20% of attacks). All the secondary endpoints were numerically in favor of oxygen.
Comment: This study provides documentation that oxygen is an effective treatment for cluster headache attacks. Injectable sumatriptan is approved by the FDA for this condition and is also highly effective. Some data support the use of sumatriptan, zolmitriptan, or dihydroergotamine nasal spray or high-dose zolmitriptan tablets. However, cost constraints make these treatments available only in small amounts, which is often insufficient to manage all the attacks. Furthermore, cluster headache is often comorbid with vascular disease (likely because of the high incidence of cigarette smoking in this population), and vascular disease contraindicates the use of triptans. However, the lack of portability of high-flow oxygen limits its usefulness. Individuals who smoke must be advised not to smoke in the vicinity of oxygen canisters.
— Mark W. Green, MD
Dr. Green is Professor of Neurology and Director of Headache and Pain Medicine, Mount Sinai School of Medicine, New York City.
Published in Journal Watch Neurology February 9, 2010
Citation(s):
Cohen AS et al. High-flow oxygen for treatment of cluster headache: A randomized trial. JAMA 2009 Dec 9; 302:2451.
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