Nitrous oxide for the treatment of acute migraine headache

Triner, Wayne; Bartfield, Joel M.; Birdwell, Maurice D; Raccio‐Robak, Nancy

doi:10.1016/s0735-6757(99)90118-3

Cited by 22 publications

(15 citation statements)

References 21 publications

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“…Nitrous oxide diffuses rapidly into gas filled cavities, actually diffusing in faster than nitrogen can diffuse out. 19 As a consequence, air filled cavities will increase in volume, pressure, or both. Nitrous oxide is therefore contraindicated in patients who are suspected of having a pneumothorax, bowel obstruction, or decompression sickness.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19] Once again, this analysis lacked power as there were only two events reported in patients treated with nitrous oxide and no reports in patients treated with placebo (RD 2%, 95% CI 23% to 6%, p = 0.5), and the vomiting could not definitely be attributed to nitrous oxide inhalation. In a small group of children treated with 50% nitrous oxide or intramuscular sedation for fracture reduction there were no reports of vomiting.…”

Section: Vomitingmentioning

confidence: 99%

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A systematic review of the safety of analgesia with 50% nitrous oxide: can lay responders use analgesic gases in the prehospital setting?

Faddy

Garlick²

2005

Emergency Medicine Journal

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A safe and effective form of pain relief would be an advantage in the prehospital treatment of patients experiencing extreme pain. Although used by many emergency medical services, 50% nitrous oxide (an inhaled analgesic known to have good pain relief properties) is not widely used by volunteer and semiprofessional organisations. This review aimed to determine whether 50% nitrous oxide is safe for use by first responders who are not trained as emergency medical technicians. A thorough search of the literature identified 12 randomised controlled trials investigating the use of 50% nitrous oxide (as compared with placebo or conventional analgesic regimens) in a range of conditions. The outcomes analysed for this review were: adverse events, recovery time, and need for additional medication. None of the studies compared the treatments in the prehospital setting; children were well represented. Adverse effects were rare and significant adverse outcomes such as hypotension and oxygen desaturation could not be attributed to nitrous oxide. Compared with patients receiving conventional analgesia, those receiving 50% nitrous oxide did not require additional medication any more frequently and had a faster recovery from sedative effects. The low incidence of significant adverse events from 50% nitrous oxide suggests that this agent could be used safely by lay responders.

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Section: Discussionmentioning

confidence: 99%

Section: Vomitingmentioning

confidence: 99%

A systematic review of the safety of analgesia with 50% nitrous oxide: can lay responders use analgesic gases in the prehospital setting?

Faddy

Garlick²

2005

Emergency Medicine Journal

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“…Nitrous oxide is a well‐known anesthetic, analgesic, and anxiolytic often used in dentistry and surgery. Triner et al compared nitrous oxide (50%) plus oxygen (50%) to oxygen (100%) alone 52 . A scented mask spray was used to blind the scent of nitrous oxide, which is mildly sweet smelling.…”

Section: Others: Octreotide Lidocaine Nitrous Oxide Propofol and mentioning

confidence: 99%

Rescue Therapy for Acute Migraine, Part 2: Neuroleptics, Antihistamines, and Others

Kelley

Tepper

2012

Headache

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Objectives.-This second portion of a 3-part series examines the relative effectiveness of headache treatment with neuroleptics, antihistamines, serotonin antagonists, valproate, and other drugs (octreotide, lidocaine, nitrous oxide, propofol, and bupivacaine) in the setting of an emergency department, urgent care center, or headache clinic.Methods.-MEDLINE was searched using the terms "migraine" AND "emergency" AND "therapy" OR "treatment." Reports were from emergency department and urgent care settings and involved all routes of medication delivery. Reports from headache clinics were only included if medications were delivered by a parenteral route.Results.-Prochlorperazine, promethazine, and metoclopramide, when used alone, were superior to placebo. Droperidol and prochlorperazine were superior or equal in efficacy to all other treatments, although they also have more side effects (especially akathisia). Metoclopramide was equivalent to prochlorperazine and, when combined with diphenhydramine, was superior in efficacy to triptans and non-steroidal anti-inflammatory drugs. Meperidine was inferior to chlorpromazine and equivalent to the other neuroleptics. The overall percentage of patients with pain relief after taking droperidol and prochlorperazine was equivalent to sumatriptan.Conclusions.-Prochlorperazine and metoclopramide are the most frequently studied of the anti-migraine medications in the emergent setting, and the effectiveness of each is superior to placebo. Prochlorperazine is superior or equivalent to all other classes of medications in producing migraine pain relief. Dopamine antagonists, in general, appear to be equivalent for migraine pain relief to the migraine-"specific" medications sumatriptan and dihydroergotamine, although there are fewer studies involving the last two. Lack of comparisons to placebo and the frequent use of combination medications in treatment arms complicate the comparison of single agents to one other.Key words: migraine, emergency, treatment, DHE, triptan, magnesium (Headache 2012;52:292-306) NOTE TO THE READERIn part 1 of this review, results of trials involving triptans, dihydroergotamine, and magnesium as rescue medications for migraine administered in emergency departments, urgent care centers, and headache clinic infusion centers were reviewed. Pertinent information concerning migraine pathophysiology and the methodology commonly used for studies of rescue migraine therapy also were included. This article (part 2) focuses on similar studies involving neuroleptics, antihistamines, serotonin antagonists, valproate, and other assorted medications (octreotide, lidocaine, nitrous oxide, propofol, and bupivacaine). Part 3 will address studies involving opioids, non-steroidal anti-inflammatory drugs, steroids, and post-discharge medications.Explanation of Methodology.-When drugs from 2 different classes of medications were compared,

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“…In our experience, the electrical threshold to induce SDs, and the frequency of SDs evoked by continuous topical KCl application, are the most reliable indicators when recorded electrophysiologically. Certain anesthetics (e.g., ketamine) inherently suppress SD susceptibility, and thus are less suitable for drug screening compared with others (e.g., α-chloralose, urethanea and barbiturates) [86-88]. Ideally, the mechanism of action of the chosen anesthetic should not overlap with that of the drug being screened (e.g., barbiturate anesthesia when testing a GABAergic drug).…”

Section: Experimental Models Of Sd Susceptibility and Caveatsmentioning

confidence: 99%

Pharmacological targeting of spreading depression in migraine

Eikermann-Haerter¹,

Can

Ayata

2012

Expert Review of Neurotherapeutics

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Migraine, particularly with aura, is a genetically heterogeneous disorder of ion channels, pumps or transporters associated with increased cortical excitability. Spreading depression, as one reflection of hyperexcitability, is the electrophysiological event underlying aura symptoms and a trigger for headache. Endogenous (e.g., genes and hormones) and exogenous factors (e.g., drugs) modulating migraine susceptibility have also been shown to modulate spreading depression susceptibility concordantly, suggesting that spreading depression can be a relevant therapeutic target in migraine. In support of this, several migraine prophylactic drugs used in clinical practice have been shown to suppress spreading depression susceptibility as a probable mechanism of action, despite belonging to widely different pharmacological classes. Hence, susceptibility to spreading depression can be a useful preclinical model with good positive and negative predictive value for drug screening.

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Nitrous oxide for the treatment of acute migraine headache

Cited by 22 publications

References 21 publications

A systematic review of the safety of analgesia with 50% nitrous oxide: can lay responders use analgesic gases in the prehospital setting?

A systematic review of the safety of analgesia with 50% nitrous oxide: can lay responders use analgesic gases in the prehospital setting?

Rescue Therapy for Acute Migraine, Part 2: Neuroleptics, Antihistamines, and Others

Pharmacological targeting of spreading depression in migraine

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