Background Impaired
oxygen utilization and cerebrovascular dysfunction are implicated in
migraine. High-flow
oxygen is effective in
cluster headache and has shown promise in animal models of
migraine, but has not been adequately studied in patients with
migraine. Methods In this randomized, crossover-design, placebo-controlled trial, adult migraineurs self-administered high-flow
oxygen or medical air
at 10-15 l/min via face mask in blinded fashion starting soon after symptom onset for 30 minutes, for a total of four
migraine attacks. Participants recorded the severity of
headache,
nausea, and visual symptoms on visual analog scales periodically up to 60 minutes. Results We enrolled 22 individuals (mean age 36 years, 20 women) who self-treated 64
migraine attacks (33
oxygen, 31 air). The pre-specified primary endpoint (mean decrease in
pain score from baseline to 30 minutes) was 1.38 ± 1.42 in
oxygen-treated and 1.22 ± 1.61 in air-treated attacks ( p = 0.674).
Oxygen therapy resulted in relief (severity score 0-1) of
pain (24% versus 6%, p = 0.05),
nausea (42% versus 23%, p = 0.08) and visual symptoms (36% versus 7%, p = 0.004) at 60 minutes. Exploratory analysis showed that in moderately severe attacks (baseline
pain score <6),
pain relief was achieved in six of 13 (46%)
oxygen versus one of 15 (7%) air ( p = 0.02). Gas
therapy was used per protocol in 91% of attacks. There were no significant adverse events. Conclusion High-flow
oxygen may be a feasible and safe strategy to treat acute
migraine. Further studies are required to determine if this relatively inexpensive, widely available treatment can be used as an adjunct or alternative
migraine therapy.