Intraoral Chilling Versus Oral Sumatriptan for Acute Migraine

Abstract

Migraine pathophysiology is associated with a dural inflammation. Recent evidence suggests that the primary inflammation occurs in a maxillary nerve segment, accessible intraorally. Local tenderness, related to symptom laterality, has been palpated consistently in asymptomatic migraine patients, and significant migraine relief has been obtained from chilling confined to this area. Thirty-five symptomatic episodic migraine patients were enrolled in this study, comparing 40 minutes of bilateral intraoral chilling, 50 mg of oral sumatriptan, and 40 minutes of sham (tongue) chilling. Hollow metal tubes chilled by circulating ice water were held in the maxillary molar periapical areas by the patient. Pain and nausea were recorded at baseline and 1, 2, 4, and 24 hours after start of treatment, using a numeric symptom-relief scale. Significant mean headache relief was obtained by maxillary chilling and sumatriptan at all four time intervals, with poor relief obtained by placebo. Maxillary chilling was more effective than sumatriptan at all four time intervals. Significant nausea relief was obtained by maxillary chilling and sumatriptan at posttreatment and 2 and 4 hours later. At 24 hours, some headache and nausea recurrence was noted with sumatriptan. The repeated-measures analysis of variance indicated that both treatments, drug (P = 0.024) and maxillary chilling (P = 0.001), reduced the headache, as compared with the control group. Tenderness suggests local inflammation associated with vasodilatation and edema. Because chilling can resolve local edema, these findings raise the possibility that an intraoral inflammation may be a factor in migraine etiology.

Cold Therapy in Migraine Patients: Open‐label, Non‐controlled, Pilot Study

“…In a small study, Friedman et al . (11) reported the efficacy of a non-invasive technique, intra-oral chilling, for acute migraine headache pain when compared with oral sumatriptan or placebo. Lance (12) reported the results of a new device, which employs cold, pressure and heat around the head.…”

Local Inflammation as a Mediator of Migraine and Tension‐Type Headache

“…Results at pre, post, 2, 4, and 24 hours later: for sumatriptan 7.3, 4.6, 3.54, 2.75, and 2.92; for intraoral chilling 7.33, 3.5, 2.33, 2.04, and 1.1; for tongue chilling 7.2, 6.0, 5.6, 5.8, and 4.36. 15 Topical Ketoprofen Headache Prevention Study.-Headache burden, which equals total monthly headache hours × average severity (0 to 10 scale) decreased from 454.8 (30-day baseline) to 86.5 P < .001 during the 30-day treatment phase. Analgesic and headache medication intake were significantly reduced from baseline during the treatment phase, with minimal side effects.…”

“…16 Department In a randomized fashion, the patients were treated by 40 minutes of ICH, as in the above experiment, 50 mg of oral sumatriptan, or 40 minutes of tongue chilling, using the same device. 15 Topical NSAID Gel Study.-Twenty episodic migraine, TTH, and post-traumatic headache patients were enrolled in an open-label headache prevention study. Fifteen of the patients were referred by the co-authors of previous studies.…”

“…Results at pre, post, 2, 4, and 24 hours later: for sumatriptan 7.3, 4.6, 3.54, 2.75, and 2.92; for intraoral chilling 7.33, 3.5, 2.33, 2.04, and 1.1; for tongue chilling 7.2, 6.0, 5.6, 5.8, and 4.36 15 …”

“…Department of Medicine Controlled Migraine Study.— Thirty‐five symptomatic episodic migraine patients were treated in the outpatient department of the New York Medical College Department of Medicine and a faculty practice at St. Agnes Hospital during severe migraine (average duration 17.4 hours). In a randomized fashion, the patients were treated by 40 minutes of ICH, as in the above experiment, 50 mg of oral sumatriptan, or 40 minutes of tongue chilling, using the same device 15 …”