Original Contribution
Efficacy of high-flow oxygen therapy in all types of headache: a prospective, randomized, placebo-controlled trial

https://doi.org/10.1016/j.ajem.2012.02.010Get rights and content

Abstract

Objective

We aimed to assess the efficacy of oxygen inhalation therapy in emergency department (ED) patients presenting with all types of headache.

Method

We performed a prospective, randomized, double-blinded, placebo-controlled trial of patients presenting to the ED with a chief complaint of headache. The patients were randomized to receive either 100% oxygen via nonrebreather mask at 15 L/min or the placebo treatment of room air via nonrebreather mask for 15 minutes in total. We recorded pain scores at 0, 15, 30, and 60 minutes using the visual analog scale. At 30 minutes, the patients were assessed for the need for analgesic medication. Patient headache type was classified by the treating emergency physician using standardized diagnostic criteria.

Results

A total of 204 patients agreed to participate in the study and were randomized to the oxygen (102 patients) and placebo (102 patients) groups. Patient headache types included tension (47%), migraine (27%), undifferentiated (25%), and cluster (1%). Patients who received oxygen therapy reported significant improvement in visual analog scale scores at all points when compared with placebo: 22 mm vs 11 mm at 15 minutes (P < .001), 29 mm vs 13 mm at 30 minutes (P < .001), and 55 mm vs 45 mm at 60 minutes (P < .001). When questioned at 30 minutes, 72% of patients in the oxygen group and 86% of patients in the placebo group requested analgesic medication (P = .005).

Conclusion

In addition to its role in the treatment of cluster headache, high-flow oxygen therapy may provide an effective treatment of all types of headaches in the ED setting.

Introduction

Headache is a common symptom in patients presenting to the emergency department (ED), accounting for 2% percent of ED visits [1], [2]. Primary type headache disorders including migraine or tension-type headaches are diagnosed in most of these patients presenting with headache. The main goals of ED management include evaluation for possible life-threatening causes of headache, such as infection or hemorrhage, and provision of rapid and effective relief of pain [3]. Although primary headache disorders may result from distinct epidemiologies, these headache types have also demonstrated overlapping responses to therapy. The use of nonsteroidals, triptans, dihydroergotamine, and the antiemetic dopamine antagonists may play a therapeutic role for each of these acute headache types [1].

The use of oxygen inhalation therapy in cluster headaches is well established and is used routinely in this treatment area. It is unknown, however, whether oxygen may be effective in the treatment of other types of headache. Although the exact mechanism of oxygen efficacy in cluster headaches is unclear, it has been postulated that the cerebral vasoconstrictive effect contributes to its effectiveness [4].

Possible benefits of oxygen treatment for patients with headache include rapid pain relief, reduction in the need for additional analgesia, and decreased length of ED stay. Furthermore, oxygen may provide an effective treatment option in combination with other medications. Considering the overlapping responses of other headache therapies, we hypothesized that oxygen may be used as an effective treatment for ED patients presenting with all types of headache. The intention of our study was to assess the efficacy of high-flow oxygen therapy in all types of headache by evaluating the effect of oxygen on pain scores, the need for additional analgesia, and ED length of stay (LOS).

Section snippets

Study design and setting

During the 14-month period from September 2009 through October 2010, we conducted a prospective, double-blinded, placebo-controlled, randomized trial in the Gulhane Military Medical Academy Emergency Department, an urban, academic, tertiary care referral center located in Ankara, Turkey, with an annual census of 120 000 patient visits. The study was approved by the institutional review board, and informed consent was obtained from all participants.

Selection of participants

We consecutively enrolled a convenience sample

Results

Two hundred thirty-eight patients were screened for eligibility for the study, and 34 of these patients were excluded. Most patients who were excluded met at least 1 of the predefined exclusion criteria, whereas a few of these patients declined to consent to participate (Fig. 1). A total of 204 patients agreed to participate in the study and were randomized to the oxygen (102 patients) and placebo (102 patients) groups. All analyses were undertaken on an intention-to-treat basis.

Mean patient

Discussion

Our study demonstrated that oxygen may be useful in the treatment of all types of headaches in patients presenting to the ED. Oxygen was effective both in reducing the pain scores and the need for additional analgesia in patients with primary headache disorders. Patients who received oxygen reported significant improvement in VAS scores at all points (15, 30, 60 minutes) when compared with placebo. This difference in scores reached its maximum at 30 minutes.

Although we found that oxygen was

References (9)

There are more references available in the full text version of this article.

Cited by (30)

  • Comparing the effects of 3 oxygen delivery methods plus intravenous ketorolac on primary headaches: A randomized clinical trial

    2020, American Journal of Emergency Medicine
    Citation Excerpt :

    The length of stay (LOS) in the ED was also recorded by the nurse investigator. Based on a previous study conducted by Ozkurt et al. [3], we determined a priori that a minimum of 34 patients would be needed in each treatment group to detect a 1.3-cm difference in VAS [9] between groups, with 80% power and a two-sided α level of 0.05. Values were expressed as frequency (number and percentage) or median (interquartile range, IQR, presented as the range between the 75th and 25th percentiles), as appropriate.

  • The neurology literature 2016

    2017, American Journal of Emergency Medicine
  • Headache and neurologic complaints

    2017, Urgent Care Medicine Secrets
View all citing articles on Scopus

Funding and support: Nothing to declare.

View full text