Migraine Headaches and Hyperbaric Oxygen Therapy (HBOT)
In the past, migraines were thought to be due to spasms of the brain’s blood vessels. More recent research, however, suggests that there is an area in the brain with a lower threshold for migraines — a migraine generator that is sometimes even related to a traumatic event. This generator could be in the brainstem, involving serotonergic nerve cells that alter the balance of brain chemicals.
Migraines begin with the aura and aura-like phenomenon. This is the beginning of a series of events that end as migraine headache pain. This pain is part of an inflammatory response of the vessels surrounding the migraine generator area in the brain.
Drugs that combat migraines are generally effective with relatively few side effects. Persons who may benefit from hyperbaric oxygen therapy (HBOT) are those whose migraines have more of a vascular origin (induced either by imbalance of chemicals or abnormal blood flow to a particular brain area) or those who have side effects or contraindications to standard drug therapy.
HBOT has been shown to change the amount of blood flow in the brain during migraine episodes. Additionally, HBOT can favorably alter some of the chemical levels that induce migraines (serotonin and substance P). Both published and unpublished studies show that HBOT is effective in aborting a migraine headache in 80% of patients within 40 minutes of treatment. Effedal et al 2004 found that prophylactic use of HBOT to prevent headaches can reduce the number of headaches; due to the small sample size of the study, however, it did not reach statistical significance.
In summary, HBOT is an alternative therapy to abort a migraine headache without drugs and their side effects like sedation, nausea, etc. Complications and side effects of HBOT are rare at pressures less than 2 ATA, and at the conclusion of an HBOT session patients can return immediately to daily activities. Those considering HBOT for migraines/headaches should have a full neurological evaluation to make sure that there are no organic reasons for the headaches (such as mass, tumor, vascular deformities, etc.). HBOT is considered off-label usage, as are many drugs used for migraines.