Cluster headaches, also referred to as suicide headaches, are cyclic headaches that manifest in the form of short durations (15-180 minutes) of severe pain. The unilateral attacks of the trigeminal autonomic cephalalgia are linked to intracranial and extracranial autonomic symptoms. Patients experience as many as 8 attacks in a single day, with the severity increasing with each attack. In severe cases of the condition, the patients end up committing suicide as a result of the persistent pain, especially those whose disorder lacks remission periods. The nose, eyes and face take in the most wrath from the disorder.
On the other hand, migraines are associated with intense head pain as a result of neurological interruptions. Migraines are among the most common disorders in the world. The severe pain is highly sensitive to rapid movement, noises and light. Some of the most common symptoms that the patients face include nausea, drowsiness, reduced appetite, stomach upsets and upsets in bowel functioning. HBOT was explored after most forms of prophylactic therapies and abortive treatments, e.g. triptans and opiates, proved to be ineffective with time.
Mechanism of Action
Increased tissue oxygenation leads to the cranial parasympathetic pathway and trigeminoautonomic reflex blockage. This way, nerve signals causing headaches are intercepted and stopped. Stifling the stimulation of nerves that are regulated in the trigeminocervical complex also results in reduced blood flowing to certain parts of the head; the trigeminocervical complex is the part of the brain linked to headaches. Reduced blood flow has the effect of causing relief. Increased oxygenation has a cooling effect and reduces hyperactivity in the trigeminovascular system. This way, the severity of migraines and cluster headaches is reduced and finally eliminated. Cortical spreading depression, which takes place in the brain, is also addressed as the high oxygen activity in the brain suppresses this process. Brain injury and potential damage are avoided as well. Managing migraines and headaches also leads to better usage of oxygen.
Hyperbaric oxygen therapy (HBOT) also addresses the neurogenic inflammation that results from the release of neuropeptides. The most common neuropeptides in CH and migraines include substance P, calcitonin gene-related peptide, and neurokinin A. Once the release is stopped, the pain that results from the two phenomena is lowered and finally eliminated. HBOT also lessens sensitization. The lessening addresses most of the undesirable clinical symptoms linked to both CH and acute migraines. The responsiveness of neurons to stimulation is reduced while the pain threshold increases. Managing sensitization helps in getting rid of the temporal and periorbital pain that is associated with the two disorders. Oxygen also increases the efficacy of other abortive medications. Pain relief sets in faster when oxygen therapy is used. Those previously struggling with the disorders can go about their lives without having to worry about turning or shaking their heads, bending, coughing and other sudden movements.
References
Bennett, M. H., French, C., Schnabel, A., Wasiak, J., Kranke, P., & Weibel, S. (2015). Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. The Cochrane Library, 2016(1). https://doi.org/10.1002/14651858.cd005219.pub3
Mo, H., Chung, S. J., Rozen, T. D., & Cho, S. (2022). Oxygen therapy in cluster headache, migraine, and other headache disorders. The Journal of Clinical Neurology, 18(3), 271. https://doi.org/10.3988/jcn.2022.18.3.271
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