The American Journal of Emergency Medicine has an interesting paper on the use of high flow oxygen to treat headaches.
In a prospective, randomized, double-blinded, placebo-controlled trial of 204 patients presenting to the ED complaining of headache.
These patients were randomised to receive either 100% oxygen (via a non-rebreather mask @ 15 LPM) or room air via the same delivery device.
Visual analogue pain scores were recorded at regular intervals and the headache type was diagnosed and classified by the emergency doctor.
Patients who received the oxygen therapy reported significant improvement in pain scores at 15, 30 and 60 minute marks compared with the placebo group.
Both groups did request analgesia at the 30 minute mark when asked (72% Oxygen group and 86% Placebo group).
This decrease in pain scoring occurred across all types of headaches including tension, migraine, cluster and undifferentiated.
The use of oxygen therapy in the ED setting rests primarily in its ease of use, simplicity in administration, its relatively low expense, and the potential decrease in the need for additional analgesia. We did demonstrate in our study that oxygen administration resulted in a statistically significant reduction in the need for rescue analgesia. Potential ED treatment algorithms for patients with headache may include the use of oxygen in conjunction with the other analgesics or initiation of oxygen therapy with reevaluation for the need for analgesia. Given the ready accessibility and low expense of oxygen therapy in the ED setting, as well as the very-low-risk profile, there would seem to be few deterrents to the use of high-flow oxygen in headache. If additional randomized trials support our findings, oxygen therapy could become a standard of care for patients with headache in the ED.
Note: Before you rush out and stick all your patients with headaches on high-flow oxygen, remember that it is considered a drug and technically it should be charted or ordered1 before being given in such a situation.
I am also conducting my own little mini-study by covertly piping high-flow O2 into our bedroom to see if it decreases the incidence of geographical nocturnal headaches or GNH’s that Kelly seems to often get in that area of the house.
I’ll let you know how it goes.
- or at least commenced after discussion with the treating doctor [↩]