“Migraine headaches affect more than 12% of the United States population, mostly females, and result in significant impairment of quality of life and loss of productivity,” explains Rushil Shah, MBBS, MHS. “Current management of migraine includes long-term prophylaxis with daily medications, followed by administration of rescue drugs during episodes of severe acute headaches. These drug therapies can have significant side effects. Furthermore, many patients with acute migraine are treated with opiates in the emergency setting, adding to the epidemic of opiate addiction. As such, there is a need for non-drug abortive treatment for acute migraine.”

For a paper published in Cephalalgia, Dr. Shah and colleagues investigated the effect of dry gas-induced nasal cooling on migraine headaches. “Based on prior studies suggesting that the cooling effect of high-flow dry oxygen may be partly responsible for the pain relief of migraine, we hypothesized that cooling might play a role in the pain relief obtained by trans-nasal gas therapy,” he says. “The overall objective of this study was to assess the relative contribution of cooling and oxygen in alleviating pain from acute migraine headaches.”

All Therapeutic Arms Showed Reduction in Pain Scores

In the single-blind study, acute migraineurs were randomized to nasal high-flow dry oxygen, dry air, humidified oxygen, or humidified air (controls) at 15 L/min for 15 minutes. All gases were delivered at 37˚C. Severity of headaches and other migraine-associated symptoms were recorded before and after therapy. The primary endpoint was change in pain scores, with changes in nausea, photosensitivity, and sound sensitivity scores serving as secondary endpoints. A linear regression model was employed to estimate the impact of individual treatment components and their individual interactions.

All three therapeutic arms (dry oxygen, humidified oxygen, and dry air) showed a significantly greater reduction in pain scores at 2 hours of therapy when compared with the control arm (humidified air). A significantly greater reduction in 2-hour photosensitivity scores was also noted in all therapeutic arms when compared with controls. “The presence of oxygen and dryness were independently associated with significant reductions in pain and photosensitivity scores,” says Dr. Shah. “Trans-nasal high-flow dry gas results in significant reduction in headache and other migraine symptoms. Our findings suggest that both the cooling effect of the dry air and the vasoconstrictive effects of oxygen contribute to pain relief in acute migraine headaches. High-flow trans-nasal air cooling/oxygen was well-tolerated, and there were no significant side effects.”

Outpatient Utilization

The study group observed the following results for symptom relief (Table):

  • Headache—In the dry air arm only, there was significant pain relief at 2 hours.
  • Nausea—More than 70% of patients in the dry oxygen, dry air, and humidified oxygen arms experienced relief at 2 hours.
  • Photosensitivity—Patients in the dry oxygen, dry air, and humidified oxygen arms achieved 42%, 46%, and 55% improvements in symptom scores, respectively, at 2 hours.
  • Sound Sensitivity—None of the arms achieved statistically significant relief from symptoms at 2 hours.

“Trans-nasal dry air therapy is an innovative, portable, inexpensive, and non-pharmacologic way of treating migraine that can be utilized in an outpatient setting,” Dr. Shah says. “Patients presenting with acute migraine have historically been treated with opioids, which can lead to drug dependence. If established, trans-nasal cooling therapy may become a widely available adjunctive treatment for acute migraine.”

Dr. Shah and colleagues note the need for future research focused on testing the feasibility, safety, and tolerability of this novel migraine therapy. “Additional studies that test dosing or duration effects would add to our knowledge in this area. Studies that aim to pinpoint the mechanism beyond the cooling are also needed to better optimize the therapy.”

References

Trans-Nasal High-flow Dehumidified Air in Acute Migraine Headaches: A Randomized Controlled Trial https://journals.sagepub.com/doi/10.1177/0333102421997766.