Therapeutic Effect of Intranasal Evaporative Cooling in Patients with Migraine: a Pilot Study

Overview

Journal J Headache Pain

Publisher Biomed Central

Date 2015 Jan 28

PMID 25623151

Citations 4

Authors

Jitka Vanderpol

Barbara Bishop

Manjit Matharu

Mark Glencorse

Affiliations

Soon will be listed here.

Abstract

Background: Cryotherapy is the most common non-pharmacological pain-relieving method. The aim of this pilot study was to ascertain whether intranasal evaporative cooling may be an effective intervention in an acute migraine attack. Studies have previously demonstrated effectiveness of a variety of cryotherapy approaches. Intranasal evaporative cooling due to vascular anatomy, allows the transfer of venous blood from nasal and paranasal mucous membranes to the dura mater, thereby providing an excellent anatomical basis for the cooling processes.

Methods: We conducted a prospective, open-label, observational, pilot study. Twenty-eight patients who satisfied the International Classification of Headache Disorders (ICHD 2) diagnostic criteria for migraine were recruited. A total of 20 treatments were administered in 15 patients. All patients provided pain severity scores and migraine-associated symptoms severity scores (based on a 0-10 visual analogue scale, [VAS]).

Results: Out of the 20 treatments, intranasal evaporative cooling rendered patients' pain and symptoms free immediately after treatment, in 8 of the treatments (40%), a further 10 treatments (50%) resulted in partial pain relief (headache reduced from severe or moderate to mild) and partial symptoms relief. At 2 hours, 9 treatments (45%) provided full pain and symptoms relief, with a further 9 treatments (45%) resulting in partial pain and symptoms relief. At 24 hours, 10 treatments (50%) resulted in patients reporting pain and symptom freedom and 3 (15%) provided partial pain relief. In summary 13 patients (87%) had benefit from the treatment within 2 hours that was sustained at 24 hours.

Conclusions: Intranasal evaporative cooling gave considerable benefit to patients with migraine, improving headache severity and migraine-associated symptoms. A further randomised, placebo controlled, double blinded, parallel clinical trial is required to further investigate the potential of this application.

Trial Registration: Clinicaltrials.gov registered trial, ClinicalTrials.gov Identifier: NCT01898455.

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References

ABRAMSON D . PHYSIOLOGIC BASIS FOR THE USE OF PHYSICAL AGENTS IN PERIPHERAL VASCULAR DISORDERS. Arch Phys Med Rehabil. 1965; 46:216-44. View

Merrick M . Secondary injury after musculoskeletal trauma: a review and update. J Athl Train. 2006; 37(2):209-17. PMC: 164347. View

Zachariassen K . Hypothermia and cellular physiology. Arctic Med Res. 1991; 50 Suppl 6:13-7. View

Nakajima S, Meyer J, Amano T, Shaw T, Okabe T, Mortel K . Cerebral vasomotor responsiveness during 100% oxygen inhalation in cerebral ischemia. Arch Neurol. 1983; 40(5):271-6. DOI: 10.1001/archneur.1983.04050050039004. View

Ramsey I, Delling M, Clapham D . An introduction to TRP channels. Annu Rev Physiol. 2006; 68:619-47. DOI: 10.1146/annurev.physiol.68.040204.100431. View

Castren M, Nordberg P, Svensson L, Taccone F, Vincent J, Desruelles D . Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Circulation. 2010; 122(7):729-36. DOI: 10.1161/CIRCULATIONAHA.109.931691. View

Schnabel A, Bennet M, Schuster F, Roewer N, Kranke P . [Hyper- or normobaric oxygen therapy to treat migraine and cluster headache pain. Cochrane review]. Schmerz. 2007; 22(2):129-32, 134-6. DOI: 10.1007/s00482-007-0581-0. View

Zenker W, Kubik S . Brain cooling in humans--anatomical considerations. Anat Embryol (Berl). 1996; 193(1):1-13. DOI: 10.1007/BF00186829. View

FRIEDMAN M, Peterson S, Behar C, Zaidi Z . Intraoral chilling versus oral sumatriptan for acute migraine. Heart Dis. 2002; 3(6):357-61. DOI: 10.1097/00132580-200111000-00003. View

10.

Tominaga M, Caterina M, Malmberg A, Rosen T, Gilbert H, Skinner K . The cloned capsaicin receptor integrates multiple pain-producing stimuli. Neuron. 1998; 21(3):531-43. DOI: 10.1016/s0896-6273(00)80564-4. View

11.

Van den Brande P, De Coninck A, Lievens P . Skin microcirculation responses to severe local cooling. Int J Microcirc Clin Exp. 1997; 17(2):55-60. DOI: 10.1159/000179207. View

12.

Noseda R, Burstein R . Migraine pathophysiology: anatomy of the trigeminovascular pathway and associated neurological symptoms, cortical spreading depression, sensitization, and modulation of pain. Pain. 2013; 154 Suppl 1:S44-53. DOI: 10.1016/j.pain.2013.07.021. View

13.

Ucler S, Coskun O, Inan L, Kanatli Y . Cold Therapy in Migraine Patients: Open-label, Non-controlled, Pilot Study. Evid Based Complement Alternat Med. 2006; 3(4):489-93. PMC: 1697736. DOI: 10.1093/ecam/nel035. View

14.

Julius D . TRP channels and pain. Annu Rev Cell Dev Biol. 2013; 29:355-84. DOI: 10.1146/annurev-cellbio-101011-155833. View

15.

Swenson C, Sward L, Karlsson J . Cryotherapy in sports medicine. Scand J Med Sci Sports. 1996; 6(4):193-200. DOI: 10.1111/j.1600-0838.1996.tb00090.x. View

16.

Sprouse-Blum A, Gabriel A, Brown J, Yee M . Randomized controlled trial: targeted neck cooling in the treatment of the migraine patient. Hawaii J Med Public Health. 2013; 72(7):237-41. PMC: 3727573. View

17.

DE JONG R, Hershey W, WAGMAN I . Nerve conduction velocity during hypothermia in man. Anesthesiology. 1966; 27(6):805-10. DOI: 10.1097/00000542-196611000-00013. View

18.

Busch H, Eichwede F, Fodisch M, Taccone F, Wobker G, Schwab T . Safety and feasibility of nasopharyngeal evaporative cooling in the emergency department setting in survivors of cardiac arrest. Resuscitation. 2010; 81(8):943-9. DOI: 10.1016/j.resuscitation.2010.04.027. View

19.

Zanchin G, Maggioni F, Granella F, Rossi P, Falco L, Manzoni G . Self-administered pain-relieving manoeuvres in primary headaches. Cephalalgia. 2001; 21(7):718-26. DOI: 10.1046/j.1468-2982.2001.00199.x. View

20.

Robbins L . Cryotherapy for headache. Headache. 1989; 29(9):598-600. DOI: 10.1111/j.1526-4610.1989.hed2909598.x. View