Efficacy of Oxygen Treatment Using Home Oxygen Concentrators for the Treatment of Cluster Headaches: A Randomized, Crossover, Multicenter Study

다국어 초록 (Multilingual Abstract)

Background and Purpose Oxygen treatment is the first-line acute treatment for cluster headaches (CHs), but this can be impeded by insurance coverage and oxygen-tank maintenance.
Oxygen concentrators filter nitrogen from ambient air to produce oxygen-rich gas, and can therefore be an alternative to conventional oxygen therapy using a tank. We investigated the effectiveness and safety of using two home oxygen concentrators and compared them with using oral zolmitriptan for the acute treatment of CHs.
Methods Forty patients with episodic CHs in an active cluster period were enrolled in this randomized, crossover, multicenter study. Two attacks during the cluster period were treated using oxygen delivered by connecting two home oxygen concentrators, whereas the other two attacks were treated using oral zolmitriptan (5 mg) in a random sequence. The primary endpoint was substantial pain reduction (0 or 1 on a five-point rating scale from 0 to 4 points) at 15 min after treatment.
Results In total, 125 attacks among 32 patients were randomized and treated (63 attacks using oxygen and 62 using zolmitriptan) according to the study protocol. More attacks treated using oxygen reached the primary endpoint than did those treated using zolmitriptan (31.7% [20/63] vs. 12.9% [8/62], p=0.013). After 30 min, 57.1% of the patients who received oxygen and 38.7% who received zolmitriptan reported pain relief (p=0.082). All patients treated using oxygen reported an improvement in pain, and 61.3% preferred oxygen while only 9.7% preferred zolmitriptan. No adverse events occurred during the oxygen treatment.
Conclusions Oxygen treatment administered using two home oxygen concentrators resulted in better pain relief than oral zolmitriptan in patients with episodic CHs. Our results suggest that home oxygen concentrators are capable of efficiently supplying oxygen in a similar manner to using an oxygen tank.

참고문헌 (Reference)

• 1 Fogan L, "Treatment of cluster headache. A double-blind comparison of oxygen v air inhalation" 42 : 362-363, 1985
• 2 Robbins MS, "Treatment of cluster headache : the American Headache Society evidence-based guidelines" 56 : 1093-1106, 2016
• 3 Evers S, "The use of oxygen in cluster headache treatment worldwide-a survey of the International Headache Society(IHS)" 37 : 396-398, 2017
• 4 Cheah PK, "The use of dual oxygen concentrator system for mechanical ventilation during COVID-19 pandemic in Sabah, Malaysia" 14 : 30-, 2021
• 5 Headache Classification Committee of the International Headache Society(IHS), "The International Classification of Headache Disorders, 3rd edition" 38 : 1-211, 2018
• 6 Kudrow L, "Response of cluster headache attacks to oxygen inhalation" 21 : 1-4, 1981
• 7 Mo H, "Oxygen therapy in cluster headache, migraine, and other headache disorders" 18 : 271-279, 2022
• 8 Petersen AS, "Oxygen therapy for cluster headache. A mask comparison trial. A single-blinded, placebo-controlled, crossover study" 37 : 214-224, 2017
• 9 Hardavella G, "Oxygen devices and delivery systems" 15 : e108-e116, 2019
• 10 Bahra A, "Oral zolmitriptan is effective in the acute treatment of cluster headache" 54 : 1832-1839, 2000
• 11 Cohen AS, "High-flow oxygen for treatment of cluster headache : a randomized trial" 302 : 2451-2457, 2009
• 12 Schoenen J, "Guidelines of the International Headache Society for controlled clinical trials in cluster headache" 42 : 1450-1466, 2022
• 13 Hong Y, "Exploratory study of the effectiveness of oxygen therapy using home oxygen concentrators for cluster headache" 38 : 29-32, 2020
• 14 Pearson SM, "Effectiveness of oxygen and other acute treatments for cluster headache : results from the cluster headache questionnaire, an international survey" 59 : 235-249, 2019
• 15 May A, "EFNS guidelines on the treatment of cluster headache and other trigeminalautonomic cephalalgias" 13 : 1066-1077, 2006
• 16 Rozen TD, "Cluster headache in the United States of America : demographics, clinical characteristics, triggers, suicidality, and personal burden" 52 : 99-113, 2012