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Title: Hyperbaric chamber treatment Post by Topical on Jul 6th, 2005, 4:39am A search of the board did not show any results for this treatment method. I thought I would pass it along. Treatment of a Cluster Headache Patient in a Hyperbaric Oxygen Chamber http://www.hbot4u.com/cluster.html The patient was introduced to a hyperbaric chamber at 2 atmospheres for treatment of the CH. "A 49-year-old white female with a 26-year history of cluster headaches presented with severe, sharp, right-sided retro-orbital pain for 45 minutes. She was in the midst of a 2.5-month “cluster” period, having 3-5 severe headaches per week." ..... "Within 20 minutes after initiation of the treatment (5 minutes after reaching 2 ATM ABS) the patient’s pain and nasal congestion had completely resolved. Three days later she presented with another typical cluster headache. She was given a second HBOT treatment with prompt relief of her pain. At that point her “cluster” appeared to have broken. She has not had another cluster headache since that time (seven months ago). " HYPERBARIC OXYGEN AND MIGRAINE http://www.strokedoctor.com/hbo22.htm A study of 20 people diagnosed with migraines. "One group received 100% oxygen at 1 atmosphere of pressure (normobaric) while the other received 100% oxygen at 2 atmospheres of pressure (hyperbaric). One of the 10 patients in the normobaric group achieved significant relief of headache symptoms, while 9 of 10 in the hyperbaric group found relief. ..... Based on a chi-square test, this difference is significant at the P < .005 level. Those patients who did not find significant relief from normobaric oxygen were given hyperbaric oxygen as above. All nine found significant relief. The results suggest that hyperbaric (but not normobaric) oxygen may be useful in the abortive management of migraine headache. .... Possibilities for the mechanism of this effect, in addition to vasoconstriction, include an increase in the rate of energy-producing and neurotransmitter-related metabolic reactions in the brain which require molecular oxygen." So for the migraine study it was 19 successes and 1 patient with no effect in the chamber. Has anyone heard anything more on this treatment method? |
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Title: Re: Hyperbaric chamber treatment Post by vig on Jul 6th, 2005, 10:07am "A number of operative procedures had been performed in attempts to relieve the pain. These included hysterectomy..." what? |
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Title: Re: Hyperbaric chamber treatment Post by pattik on Jul 6th, 2005, 10:53am I have a friend who had this treatment to help heal some long-term skin infections. It doesn't sound very practical for us, since the headaches come and go quickly, and getting the use of a chamber spur of the moment would be difficult. And I don't think they are very common either. |
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Title: Re: Hyperbaric chamber treatment Post by marlinsfan on Jul 6th, 2005, 10:57am Have not heard of the treatment, but can talk about chambers. I'm a certified PADI scuba instructor, so I know a little, not much, about chambers. 1 ATM of pressure is the pressure at sea level. Normobaric 100% O2 is what we do to abort. We take O2 at sea level (or thereabouts, so normobaric). The migraines were only aborted 1 out of 20. What that means is that O2 is not that great for migraines. 2 ATMs of pressure is equivalent to a sea depth of 30 feet. O2 becomes LETHAL at that ATM after 30 minutes. In a chamber, you the pressure is increased gradually. In reading first study of the single patient, it makes sense for her HA to have been aborted while taken pure O2. It took her 15 minutes to reach 2 ATMS ,so she breathed O2 for 15 minutes before reaching 2 ATMs. And then breathed O2 at 2 ATMS for 5 minutes. My headache aborts after 12 minutes of O2 at 8 LPM. If I had been that patient, my headache would have ended well before reaching the 2nd ATM. Breathing it at 2 ATMs essentially doubles the number of O2 molecules she takes in a single breath because the molecules are "pressed" together (i.e: pressure), so it makes sense for the effect to have come very quickly at that ATM. That's what pressure does, it compresses the gas. And you breath in 2x as much in the same volume. At 3 ATMs you breat in 3x as much, and so on. If, say, you need 100 cubic inches of air to fill your lungs and say that represents 100 molecules of air, at 2 ATMs you still need 100 cubic inches to fill your lungs, but it will represent 200 molecules of air. The fact that the cycle broke after the 2nd session may have been coincidence. After all, she had been in cycle for 2.5 months, long enough to end on its own. One case is not enough to make statistically sound conclusions. I'm in my 10th week of my cycle, and I sure hope it ends soon. If I do something different and my cycle ends, how do I know it was not coincidence? Sorry for the sckepticism, but I don't buy it. Jose |
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Title: Re: Hyperbaric chamber treatment Post by vig on Jul 6th, 2005, 10:59am Even though it's good, there's a few problems with that study; a sample size of 1? the attack stopped after 20 minutes? (some do anyway) WE already KNOW oxygen helps. Did it break a cycle? (I don't remember anybody saying anything about oxygen helping a cycle break even if it is a great aborter.) |
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Title: Re: Hyperbaric chamber treatment Post by Bob P on Jul 6th, 2005, 11:07am From the OUCH Library: Quote:
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Title: Re: Hyperbaric chamber treatment Post by StressFree on Jul 6th, 2005, 11:19am I thought this may be interesting to some: When hiking at high altitudes, many practice "pressure breathing" to alleviate some of the potential altitude sickness problems. One of the symptoms of high altitude sickness is headache. Usually a pounding/migraine type, but it can be fairly severe. Pressure breathing is like blowing on a trumpet. You purse your lips and cause pressure in your lungs as you breath out. It forces more oxygen into your lungs. You do this at normal breathing rate. There is chance of hyperventilating, so at sign of diziness you take a break from the breathing technique. I think someone had recommended this to me on this board some time ago. It did seem to help when 02 was unavailable. I still use it at sign of cluster cycle. In my case, I believe it has delayed or avoided cycles at times. Rich |
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Title: Re: Hyperbaric chamber treatment Post by floridian on Jul 6th, 2005, 11:41am I got interested in this treatment a few months ago, and was updating the page on it this weekend. The bottom line is that maybe it is better than plain oxygen, maybe not. The research is conflicting - the best study (placebo blinded) found no preventive effects, but used only 2 hyperbaric treatment sessions. It is pretty clear that hyperbaric oxygen aborts, but so does ordinary 100% oxygen, at a lower cost. http://www.med-owl.com/clusterheadaches/tiki-index.php?page=Hyperbaric%20Oxygen |
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Title: Re: Hyperbaric chamber treatment Post by ben_uk on Jul 6th, 2005, 12:51pm PAIN 02234 Clinical Note Hyperbaric oxygen therapy in cluster headache Francesco Di Sabato a, Bruno M. Fusco a, Paolo Pelaia b and Mario Giacovazzo a a Institute of Internal Medicine VI, Headache Center and b 1nstitute of Anesthesiology and Reanimation. University La Sapienza.Rome. 00161 Rome (Italy) (Received 8 August 1992. revision received and accepted 23 October 1992) Summary Preliminary reports have shown that hyperbaric oxygen (HBO) interrupts cluster headache (CH) attacks. In the present study, 6 of 7 patients with episodic cluster headache who were treated with hyperbaric oxygen experienced an interruption of the attack. In 3 of 6 responders the florid period of the cluster headache was interrupted. The other 3 patients remained without pain attacks for a period lasting from 3 to 6 days. In 6 different patients, a placebo treatment had no effect. The present findings clearly indicate that hyperbaric oxygen has not only a symptomatic effect on a single attack of cluster headache, but it also could prevent the occurrence of subsequent attacks. Key words: Cluster headache; Hyperbaric chamber; Oxygen therapy; Cerebrovascular district Introduction Cluster headache (CH) is characterized by a series of sudden attacks of severe pain accompanied by autonomic symptoms, localized in an area around the eye on one side. Usually the attacks occur daily (1 to several a day, typically at a fixed hour) for a period lasting from 1 to several months. Administration of oxygen during the CH attack has been demonstrated to reduce/interrupt the pain attack in 70% of the patients (Kudrow 1981; Fogan 1985). The percentage appears to be less in our clinical experience. This effect may be due to a vasoconstrictive action of the oxygen (Nakajima 1983). Moreover, the beneficial effect, when present, is often short-lasting in comparison with the duration of the attack. For these reasons the use of this procedure is limited. Preliminary reports indicate that the administration of hyperbaric oxygen (HBO) is effective in relieving the CH attacks (Porta et al. 1991; Weiss 1989) and this effect may be caused by a strong vasoconstriction in the cerebrovascular bed (Miller 1981). This study evaluates the effect of HBO on CH attacks in 7 patients affected by an episodic form. This effect was compared with that obtained in 6 patients by using a placebo procedure (exposure to the hyperbaric chamber, without administering HBO). Correspondence to: Francesco Di Sabato. Institute of Internal Medicine VI, Headache Center, University La Sapienza Rome. Viale del Policlinico. 00161 Rome. Italy. Subjects and methods Thirteen patients (12 men and 1 woman) suffering from an episodic form of CH participated in the study: 7 (mean age: 45.8 + 4.8 years) were administered with HBO and 6 (mean age: 42.3+5.2 years) underwent the placeho procedure. The diagnosis was made following the criteria of the Ad hoc Committee on Classification of Headache (Headache Classification Committee 1988). Before admission to the trial, each patient was given a complete physical examination. A careful otorhinolaryngoiatric visit was also performed. The instrumental examination also included radiography of the chest and electrocardiography. Patients suffering from diseases other than CH were excluded; also excluded were patients who were taking drugs used in the prophylaxis of headache. Informed consent was obtained in each case. The patients were in the florid phase of the CH attacks, from 10 to 15 days after its initiation. Each patient was examined at the time of an attack. Five minutes after onset of the attack the subjects were placed into a pluriplace-pluriambient hyperbaric chamber (Galeazzi). The 7 patients receiving the effective treatment reached a 15 mt depth (2.5 atmosphere absolute (ATA)) at a descending rate of 0.8 mt/mm by compressed air (Sukoff and Ragatz 1976). After placing them in the chamber, the pressure was gradually increased to 2.0 ATA over a 15-min period. The patients chosen for the placebo procedure were placed in the same environment without administering HBO. For all patients (either those receiving the effective treatment or the placebo) exposure to the hyperbaric chamber lasted 30 mm. An observer who did not know the nature of the administration registered the duration of the attacks during treatment. The arithmetical mean of the duration of the last 3 attacks, occurring before the test, was computed and compared to the duration of the attacks occurring during HBO administration. Chi-square analysis was used for this purpose. After exposure to the hyperbaric chamber each patient was followed up for the duration of the cluster period. Edit-Typo's |
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Title: Re: Hyperbaric chamber treatment Post by ben_uk on Jul 6th, 2005, 12:52pm Results In 6 out of 7 patients, HBO resulted in an interruption of the current CH attack, ranging from 5 to 13 mm after the onset of treatment. The remaining patient did not show any significant change in duration/ intensity of the attack. The duration of the attacks present during the treatment session was statistically reduced in comparison with values before the test (P < 0.01, chi-square test) (Fig. 1). None of the patients who were chosen for the placebo procedure showed changes in the duration of their attacks, and no statistical difference was found in comparison with the values before the test (Fig. 1). During the follow-up period, lasting 2 months, among the patients in whom a beneficial effect was observed, 3 reported complete interruption of their cluster period. In the other 3 patients, CH attacks were not present for a period lasting from 4 to 6 days. After such a period the attacks reappeared with the same intensity and duration as during the pre-treatment period. The patient who was insensitive to HBO was treated again in the hyperbaric chamber (this time not during an attack) but also in this case no beneficial effect was observed. In the patients undergoing the control procedure the occurrence of successive CH attacks remained unmodified. Adverse reactions (particularly barotrauma) were not observed in any patient. Discussion The present results demonstrate that exposure to HBO has a beneficial effect on the pain attacks of patients suffering from CH and confirm preliminary findings (Weiss 1989; Porta et al. 1991). In particular, the administration of HBO during an attack of CH dramatically interrupted the pain a few minutes after the onset of treatment. This effect was present in all patients, except one, who underwent treatment. A placebo effect, produced by the procedure required for hyperbaric treatment, is excluded as no changes were found in the duration of the attacks in the group of patients placed into the hyperbaric chamber but not receiving HBO. Administration of pure oxygen (which could directly affect CH attacks) was avoided in the control procedure as the aim was first to eliminate the existence of a placebo effect. The choice of two different groups of patients, one for the real treatment and the other for the placebo procedure, was motivated by the fact that administration of HBO produces easily recognizable sensations (such as ringing in the ears). Such a choice allowed us to carry out a controlled study, along with the fact that the observer recording the effect of the treatment was different from the operator of the hyperbaric chamber and worked under blind conditions. Although not perfect, this is, in our opinion the best available way to obtain a double-blind condition, i.e., the ideal in validating data from a therapeutic procedure. An interesting observation arises from the present study: in 3 patients treated with HBO there was a definitive interruption of the cluster period, whereas in the other 3 patients the CH attacks were not present during the days immediately following treatment. This result indicates that a single treatment in the hyperbaric chamber could also have a long-lasting effectiveness in preventing the occurrence of CH attacks. From this point of view, the procedure could represent a complete therapeutical approach for the syndrome. Various mechanisms could explain the effect of HBO in CH,. First, HBO induces a congruous vasoconstriction (Miller 1981; Fisher et al. 1988); moreover it increases diffusion of oxygen in the tissues, thus possibly reducing cerebral hypoxia. HBO also could have an anti-oedema effect on either the vasal wall or the interstitial space (Sukoff 1968; Sukoff and Ragatz 1982). Finally, another possible explanation for the HBO effect could be the stimulation of serotonin synthesis in the central nervous system (Costa and Meek 1974). The results of the present study are promising and merit further verification. Particularly interesting would be a controlled comparison between the effects of HBO and oxygen therapy in CH. Edit-Typo's |
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Title: Re: Hyperbaric chamber treatment Post by Topical on Jul 6th, 2005, 5:42pm There is a definite problem is getting to the chamber during an attack. It might be interesting to reserve time in the chamber, after the chamber was at 2ATM take nitroglycerin which will bring on an attack. Observe the results. I don't know if this is trypically done in clinical testing for CH or would affect the end result. Does anyone know? This link is very informative about the treatment, side effects, and when the treatment is not advisable. You must obtain a prescription prior to treatment. Keep in mind that they are in the business of selling the treatment so there is some bias. (Just look at their homepage for that.) http://www.hboinfo.com/new_page_4.htm I called them as they are local to me. Treatment cost 280 per session, 240 for 5 sessions and 220 for 10 sessions. They have treated a number of migraine sufferers whose headaches last 2-3 days. They are heavily booked and stated that if the attack occurs call them to see if anyone has cancelled their appointment. That is not very practical. He did not seem to know much about CH. He did state that complete remission from headaces has not been seen but a delay before the next headache measured in days is common. (This was for migraine sufferers). After informing him of CH and the positive trial results. I tried pitching the increase in business if they did look into the treatment for CH. He stated that they don't do trials only treatment and given that they are booked solid there is little need to look for an increase in their business. That was honest. Unless taking nitro and going into the chamber will work this is not a very practical treatment therapy. I am tempted to just reserve a few sessions to see if the headache has to be present for any benefit to be seen. CH sufferers that have attacks at a specific time in the day, have responded well to O2 may be best suited to treatment. Unfortunately most of us have attacks at night and places like this one would be closed. I believe the studies do not look to good for chronic CH only episodic. |
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Title: Re: Hyperbaric chamber treatment Post by Pinkfloyd on Jul 6th, 2005, 10:08pm on 07/06/05 at 10:07:34, vig wrote:
I know of MANY women that have gone through this procedure in an attempt to stop severe migraines. Some women have their migraines stop during pregnancy. Other's after non-planned hysterectomies. Some have seen relatives outgrow their migraines after menopause. Many women suffer from what appear to be hormonal migraines, based on the timing so they try it. Doesn't work very well for many though. Then they end up taking HRT to stop other problems and the HRT makes their migraine problems even worse. :-/ I imagine more than one woman with clusters has had it done. Either thinking they were migraines at the time or thinking their clusters were/are hormone related. Bobw |
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Title: Re: Hyperbaric chamber treatment Post by Ueli on Jul 6th, 2005, 10:53pm From http://www.hbot4u.com/cluster.html Quote:
amitriptyline, various non-steroidal antinflammatory drugs, narcotics, beta blockers, not typical CH drugs. Obviously not tried: Imitrex injections, normobaric oxygen, and none of the more exotic CH preventatives. It looks like she was treated by a not so CH savvy doc. Quote:
After 20 minutes in the chamber the patient was pain free. Add to this time from the start of the attack to the start of the treatment. I'm not impressed by this plug of an institution looking for more business. The success stories form http://www.strokedoctor.com/hbo22.htm about hyperbaric treatment of meegraines are not of much interest here. The OUCH Library article quoted by Bob P says nothing about frequency and intensity of subsequent cluster attacks. Can we assume no positive results in this respect? IMHO, unless you have a pressure chamber in your basement, HBO is not worthwhile. You'll will suffer from a full blast attack while travelling to the pressure chamber and then lie down in a narrow tube until the attacks subsides. No, thank you. If I go my normobaric oxygen at the first sign, the attack never rises above Kip 3. An other observation: All the reports about HBO are 10 - 15 years old. Does this mean all the problems have been resolved long time ago (we just didn't hear about it) or was it a dead-end street, not worth investigating further? Decide for yourself. on 07/06/05 at 17:42:22, Topical wrote:
Ueli, a firm believer in normobaric oxygen for home use [smiley=smokin.gif] |
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Title: Re: Hyperbaric chamber treatment Post by mcf69 on Jul 7th, 2005, 12:12am Interesting stuff. I'm a little skeptical of the whole remision thing though for a couple reasons. First the effects of hyperbaric oxygen therapy are relatively short term, it only lasts for a couple days at most before the body "blows off" the excess oxygen. Second, if raising the blood level of oxygen and thus increasing O2 levels in body tissue (ie-the brain), why don't we get this effect from breathing 100% O2 from a mask, I know that HBOT increases cellular oxygen absorption, but see reason #1 above........ |
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Title: Re: Hyperbaric chamber treatment Post by Topical on Jul 7th, 2005, 1:43am I think the blowing off of excess oxygen would happen in much less time than a few days. There are other things happening like that elusive Substance P. See floridian's excellent site for information on this. (Thanks for the update BTW, floridian.) Maybe we should contact one of the doctors who ran the CH study to find out what happened. No doubt a lack of funding. Drug companies are not likely to pay for research in this area. They want repeat customers. "why don't we get this effect from breathing 100% O2 from a mask" - mcf69 During treatment the oxygen molecules are more tightly packed together as you are at 2 times the normal pressure. See StressFree's comment above. It will be interesting to try what he describes while wearing an oxygen mask. I'll give it a shot. (Although manually increasing the pressure inside your body sounds like it would be painful, doesn't it?) Can a small amount of oxygen can be absorbed through the skin not only the lungs? Are all these oxygen skin care products quackery? Michael Jackson used to sleep in a chamber. Does anyone have a child with CH? (Scratch that!) ;;D |
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Title: Re: Hyperbaric chamber treatment Post by dirky on Jul 7th, 2005, 5:32am I knew people who operated a new hyperbaric facility in my home town. I'd agree with the sentiment that they are trying to sell treatment so you should be wary of claims of effectiveness. Regarding hyperbaric oxygen toxicity, Marlinsfan said "O2 becomes LETHAL at that ATM after 30 minutes" As I understand it the effect would firstly be unconsciousness/coma. For a diver this could well be Lethal as he may then drown. In a chamber, the situation is a tad safer, though I imagine not much fun. |
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Title: Re: Hyperbaric chamber treatment Post by ben_uk on Jul 7th, 2005, 6:55am http://www.blackwell-synergy.com/doi/abs/10.1111/j.1526-4610.1995.hed3505260.x;jsessionid=aIUFJYvl2IY-?cookieSet=1&journalCode=hed Headache: The Journal of Head and Face Pain Volume 35 Issue 5 Page 260 - May 1995 doi:10.1111/j.1526-4610.1995.hed3505260.x Preventive Effects of Hyperbaric Oxygen in Cluster Headache Julio Pascual ; Galo Peralta ; Ubaldo Sánchez The effect of a 2-week course of hyperbaric oxygen on both the duration and frequency of cluster headache attacks was tested in four patients suffering from chronic cluster headache with no clear response to pharmacological treatments. Two patients (two courses in one case) dramatically improved while on hyperbaric oxygen treatment, this positive response remaining for 2 and 31 days posttreatment. Case 3 only improved in frequency, while the remaining patient showed no benefit. These findings suggest that daily hyperbaric oxygen treatment can be used as a transient preventive treatment for desperate cluster headache sufferers. Link for previous post http://www.richmond-hyperbaric.com/RHHC.studies.Headaches.htm |
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