Inhaler Effective for Treating Migraine Attacks, According to Pilot Study

In some instances, migraine can be treated without medicine, meaning some patients with migraine can cut down on their medication use, according to a new study that demonstrated efficacy with an inhaler that slightly changes the body’s own molecules.

Previous research has shown that the early stages of migraine attacks are characterized by cerebral vasocontstriction, indicating hypoperfusion—or decreased blood flow—as a migraine trigger. The study, assessing a compact partial rebreathing device (PRD), found the device to be effective in inducing normoxic hypercapnia, which increases brain oxygen delivery.

The researchers conducted the double-blinded, cross-over pilot study among patients with migraine with aura (MA) between November 2016 and October 2017. Patients were randomized to use either the PRD or a sham device.

“Notably, stable normoxic hypercapnia can be achieved by a PRD, which works by capturing a controlled fraction of the expired air, which is then rebreathed together with a controlled amount of atmospheric air,” explained the authors. “The net effect is a moderate reduction of alveolar ventilation, in spite of the increase in minute ventilation elicited by raising the arterial CO₂ tension (P_aCO2). By nature of its particular design, the PRD is able to induce a steady state of moderate hypercapnia while retaining normal arterial oxygen saturation.”

The 11 patients self-administered the PRD or a sham device for 20 minutes at the onset of their aura symptoms and then again after 40 minutes. Patients recorded the severities of 4 symptoms at first aura symptoms, immediately after the first device use, and after 1, 2, and 24 hours, on a scale of 0-3. After having 2 migraine attacks, the patients switched to the othe device. At the end of the study period, there was a total of 41 migraine attacks.

The PRD increased the mean End Tidal CO₂ by 24%, while retaining an average oxygen saturation above 97%.

"We utilize CO2 and oxygen, which are the body's natural molecules for mobilizing its own defence against migraine attacks. The inhaler expands the blood vessels that supply the brain with oxygen by up to seventy per cent and thereby stops the destructive chain reaction," Troels Johansen, MSc, PhD, department of clinical medicine, Aarhus University, headache clinic at Aarhus University Hospital, and study author, explained in a statement.

Furthermore, pain relief increased significantly with each use of the inhaler, as 45% experienced an effect the first time and 78% experienced an effect by the second time. According to the results, no adverse effects had occurred and the side effects were absent or mild.

The authors emphasized the need for further studies in order to investigate the efficacy of the partial rebreathing device in a larger population and in migraine without aura.

“The small scale of this study naturally restricts the strength of the conclusions that can be drawn, as does the effect that cognitive impairment during MA attacks could have on self-reported symptom scores,” stated the authors. “Additionally, since attacks were treated at home, we cannot confirm that treatment was performed correctly or for the intended duration.”

Reference:

Fuglsang C, Johansen T, Kaila K, et al. Treatment of acute migraine by a partial rebreathing device: A randomized controlled pilot study [published August 22, 2018]. Cephalalgia. doi: https://doi.org/10.1177/0333102418797285.