For the Most Painful Headaches, a Simple, Drug-Free Treatment Usually Works

Clusters headaches cause pain that ranks among the worst that can be experienced. Sufferers compare them to what they imagine it would be like to have knives piercing through their eyebrows or temples. But for most patients a simple treatment with pure oxygen can relieve cluster headache pain without drug side effects, according to a new study published in the December 9 edition of the Journal of the American Medical Association. Among those afflicted, episodes of cluster headaches often occur frequently, even daily, over weeks or months. This long bout usually is followed by months or years of remission before the onset of another headache cluster. The headaches typically last from 15 minutes to three hours. Some patients experience chronic cluster headaches, with prolonged episodes that may last a year or longer and shorter remissions. Injections of sumatriptan are the favored drug treatment for cluster headaches. Formulated as a pill, sumatriptan also is commonly prescribed as a treatment for migraine headaches. Sumatriptan injections should be limited to no more than two daily. Patients with some common health conditions -- such as heart disease, elevated stroke risk, or poorly controlled high blood pressure -- should not receive sumatriptan injections. As an alternative, researchers led by UCSF headache specialist Peter Goadsby, MD, PhD, compared oxygen delivered through a face mask to a placebo – the normal air we breathe. Goadsby and collaborators evaluated treatment results in 57 episodic cluster headache patients and 19 chronic cluster headache patients. Patients administered the treatment themselves. Each patient received four oxygen treatments and four placebo treatments. Fifteen minutes of treatment with oxygen delivered through a face mask from compressed air cylinders at a flow rate of 12 liters per minute resulted in patients becoming pain free, or experiencing good or excellent pain relief, in 78 percent of headache episodes. In contrast, only 20 percent of headache occurrences treated with the placebo resulted in a similar degree of pain relief within the same time frame. There were no adverse side effects associated with oxygen treatment in the study. The study was double-blinded, meaning that researchers and patients did not know which treatment had been given at the time when its effectiveness was graded. The study is the first to put the use of oxygen to treat cluster headaches on firm scientific footing, according to the researchers. In their JAMA report they state, “To our knowledge, this is the first adequately powered trial of high-flow oxygen compared with placebo, and it confirms clinical experience and current guidelines that inhaled oxygen can be used as an acute attack therapy for episodic and chronic cluster headache.”

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Science Café: Hope for Headaches: A Conversation with Headache Expert Peter Goadsby
June 6, 2008 UCSF Headache Clinic