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Treatment of a Cluster Headache Patient in a Hyperbaric Oxygen Chamber

Larry D. Weiss, M.D., Sai S. Ramasastry, D.D., and Benjamin H. Eidelman, M.D.

Synopsis

A patient with severe cluster headaches was treated in a Hperbaric Oxygen chamber on two occasions. Her symptoms had been refractory to other treatment modalities including conventional oxygen therapy. On both occasions her pain was promptly relieved while breathing 100% oxygen at two atmospheres of pressure. This is the first known reported case of a cluster headache treated with hyperbaric oxygen. A prospective study is needed to substantiate the efficacy of this treatment modality for cluster hedaches.

Case Report

A 49-year-old white female with a 26-year history of cluster headaches presented with severe, sharp, right-sided retro-orbital pain for 45 minutes. She was in the midst of a 2.5-month “cluster” period, having 3-5 severe headaches per week. The latter had been resistant to multiple drug therapy, including ergotamine, amitriptyline, methysergide, prednisolone, lithium, various non-steroidal anti-nflammatory drugs, narcotics, calcium channel blockers, beta blockers, and intranasal lidocaine. A number of operative procedures had been performed in attempts to relieve the pain. These included hysterectomy, arterial embolisation, microvascular decompression of the 5th nerve, and local nerve blocks. Because of the debilitating and resistant nature of the patient’s headaches, permission was obtained from our Institutional Review Board for emergency treatment of this patient in a hyperbaric chamber.

Appropriate informed consent was obtained from the patient after the experimental nature of the treatment had been explained. The patient presented with a typical headache prior to the first hyperbaric treatment. After being placed in the chamber, the pressure was gradually increased to 2 ATM ABS over a 15-minute period. Within 20 minutes after initiation of the treatment (5 minutes after reaching 2 ATM ABS) the patient’s pain and nasal congestion had completely resolved. Three days later she presented with another typical cluster headache. She was given a second HBOT treatment with prompt relief of her pain. At that point her “cluster” appeared to have broken. She has not had another cluster headache since that time (seven months ago). The possibility of a placebo effect cannot be discounted. This is especially true when the parameters observed are subjective—in our patient, pain and nasal congestion. There is a physiological basis for the use of high concentrations of oxygen in the treatment of cluster headaches. The potential benefits of HBOT therapy must be weighed against the costs, inconvenience, and adverse effects.

Phillip James
Wolfson Hyperbaric Medicine Unit
University of Dundee
UK

Headache, February 1989, p. 109
Text Book of Hyperbaric Oxygen
K.K.Jain MD, Vol,2,3,

Printed with Permission