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Sunday, December 13, 2009

Oxygen and Headaches

Severe Headache May be Treated With Oxygen

Headaches seem to be a common human condition, with almost everyone having suffered one at some point in life. In the spectrum of headaches, the most severe form is known as 'cluster' headaches. Clusters are characterized by excruciating pain behind or around one eye, tearing, drooping of the eyelid, runny nose and other symptoms. More men than women get them, with women who do describing the pain as "worse than childbirth." No surprise, then, that cluster headaches are one cause of suicide.

Yikes. Now there's good news with a study in this week's Journal of the American Medical Association: High-Flow Oxygen for Treatment of Cluster Headache. In 109 patients with cluster headaches, use of 100% oxygen delivered by face mask relieved the pain in almost 80%. In a very revelatory study design, participants who received oxygen also tried just room air delivered through a face mask, and only 20% responded. Clearly then, oxygen is important, and this makes sense in light of what we do know about headaches: blood vessels seem to constrict and relax and blood flow is compromised when a headache occurs. Since blood is delivering oxygen, perhaps that's the key.

Other really great aspects to this study include the fact that oxygen is non-toxic in this setting and doesn't have side effects, unless as Rick quips in the podcast, you are a smoker and you try to use your oxygen while you're smoking. Oxygen can be self-administered, in contrast to sumatriptan, one drug known to be effective but which must be injected. All around, a win-win for those who are unfortunate enough to have cluster headaches.

Now that this study has shown oxygen's benefit in cluster headache, the way is paved to try it in much more common migraine headaches as well. Here we also known that some blood vessel component is important so it may help. Stay tuned for studies addressing the use of oxygen in this much larger population of those who get bad headaches.

Other topics in this week's podcast include soy consumption and breast cancer survival, also in this week's JAMA, a new type of anticlotting medication in this week's NEJM, and in this issue of Archives of Pediatric and Adolescent Medicine, more evidence to support placing infants to sleep on their backs to avoid SIDS. Until next week, y'all live well.

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