Bennett Michael H, French Christopher, Schnabel Alexander, Wasiak Jason, Kranke Peter
Diving and Hyperbaric Medicine, Prince of Wales Hospital, Barker Street, Randwick, NSW, Australia, 2031.
Cochrane Database Syst Rev. 2008 Jul 16(3):CD005219. doi: 10.1002/14651858.CD005219.pub2.
Migraine and cluster headaches are severe and disabling. Migraine affects up to 18% of women, while cluster headaches are much less common (0.2% of the population). A number of acute and prophylactic therapies are available. Hyperbaric oxygen therapy (HBOT) is the therapeutic administration of 100% oxygen at environmental pressures greater than one atmosphere, while normobaric oxygen therapy (NBOT) is oxygen administered at one atmosphere.
To assess the safety and effectiveness of HBOT and NBOT for treating and preventing migraine and cluster headaches.
We searched the following in May 2008: CENTRAL, MEDLINE, EMBASE, CINAHL, DORCTIHM and reference lists from relevant articles. Relevant journals were hand searched and researchers contacted.
Randomised trials comparing HBOT or NBOT with one another, other active therapies, placebo (sham) interventions or no treatment in patients with migraine or cluster headache.
Three reviewers independently evaluated study quality and extracted data.
Nine small trials involving 201 participants were included. Five trials compared HBOT versus sham therapy for acute migraine, two compared HBOT to sham therapy for cluster headache and two evaluated NBOT for cluster headache. Pooling of data from three trials suggested that HBOT was effective in relieving migraine headaches compared to sham therapy (relative risk (RR) 5.97, 95% confidence interval (CI) 1.46 to 24.38, P = 0.01). There was no evidence that HBOT could prevent migraine episodes, reduce the incidence of nausea and vomiting or reduce the requirement for rescue medication. There was a trend to better outcome in a single trial evaluating HBOT for the termination of cluster headache (RR 11.38, 95% CI 0.77 to 167.85, P = 0.08), but this trial had low power.NBOT was effective in terminating cluster headache compared to sham in a single small study (RR 7.88, 95% CI 1.13 to 54.66, P = 0.04), but not superior to ergotamine administration in another small trial (RR 1.17, 95% CI 0.94 to 1.46, P = 0.16). Seventy-six per cent of patients responded to NBOT in these two trials. No serious adverse effects of HBOT or NBOT were reported.
AUTHORS' CONCLUSIONS: There was some evidence that HBOT was effective for the termination of acute migraine in an unselected population, and weak evidence that NBOT was similarly effective in cluster headache. Given the cost and poor availability of HBOT, more research should be done on patients unresponsive to standard therapy. NBOT is cheap, safe and easy to apply, so will probably continue to be used despite the limited evidence in this review.
偏头痛和丛集性头痛严重且使人丧失能力。偏头痛影响多达18%的女性，而丛集性头痛则要少见得多（占人口的0.2%）。有多种急性和预防性治疗方法。高压氧疗法（HBOT）是在高于一个大气压的环境压力下给予100%的氧气，而常压氧疗法（NBOT）是在一个大气压下给予氧气。
评估HBOT和NBOT治疗和预防偏头痛及丛集性头痛的安全性和有效性。
我们于2008年5月检索了以下数据库：Cochrane系统评价数据库、医学索引数据库、荷兰医学文摘数据库、护理学与健康领域数据库、Cochrane对照试验中心注册库以及相关文章的参考文献列表。对相关期刊进行了手工检索并联系了研究人员。
比较HBOT或NBOT与彼此、其他积极治疗、安慰剂（假）干预或不治疗偏头痛或丛集性头痛患者的随机试验。
三位评价者独立评估研究质量并提取数据。
纳入了9项涉及201名参与者的小型试验。5项试验比较了HBOT与假治疗用于急性偏头痛，2项试验比较了HBOT与假治疗用于丛集性头痛，2项试验评估了NBOT用于丛集性头痛。对三项试验的数据合并表明，与假治疗相比，HBOT在缓解偏头痛方面有效（相对危险度（RR）5.97，95%置信区间（CI）1.46至24.38，P = 0.01）。没有证据表明HBOT可以预防偏头痛发作、降低恶心和呕吐的发生率或减少急救药物的需求。在一项评估HBOT用于终止丛集性头痛的试验中有结果更好的趋势（RR 11.38，95% CI 0.77至167.85，P = 0.08）但该试验效能较低。在一项小型研究中，与假治疗相比，NBOT在终止丛集性头痛方面有效（RR 7.88，95% CI 1.13至54.66，P = 0.04），但在另一项小型试验中并不优于麦角胺给药（RR 1.17，95% CI 0.94至1.46，P = 0.16）。在这两项试验中，76%的患者对NBOT有反应。未报告HBOT或NBOT的严重不良反应。
有一些证据表明HBOT对未选择人群的急性偏头痛终止有效，而证据薄弱表明NBOT在丛集性头痛中同样有效。鉴于HBOT的成本和可用性差，应对对标准治疗无反应的患者进行更多研究。NBOT便宜、安全且易于应用，因此尽管本综述中的证据有限，但可能会继续使用。
