Hypercapnia may treat Migraine without medicines

Normoxic hypercapnia may be considered as a promising adjunctive/alternative migraine treatment, reports a study published in the journal Cephalalgia.

Hypercapnia, also known as hypercarbia and CO₂retention, is a condition of abnormally elevated carbon dioxide (CO₂) levels in the blood. According to the results of a pilot study by slightly changing the body's own molecules using a small inhaler, certain migraine patients can either cut down on medication or do without it completely.

Stable normoxic hypercapnia can be achieved by a partial rebreathing device (PRD) (which works by capturing a controlled fraction of the expired air, which is then rebreathed together with a controlled amount of atmospheric air. The net effect is a moderate reduction of alveolar ventilation, in spite of the increase in minute ventilation elicited by raising the arterial CO2 tension. By nature of its particular design, the PRD is able to induce a steady state of moderate hypercapnia while retaining normal arterial oxygen saturation.

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“Migraines occur as part of a chain reaction during which the veins in the brain contract and the blood cannot, therefore, supply the brain with sufficient oxygen, explains Troels Johansen, the co-author of the study. “We utilize CO2 and oxygen, which are the body's natural molecules for mobilizing its own defence against migraine attacks. The inhaler expands the blood vessels that supply the brain with oxygen by up to seventy per cent and thereby stops the destructive chain reaction, he added.

The investigators performed double-blinded, randomized, controlled, cross-over design, to check out the efficacy and safety of the PRD in the treatment of a migraine with aura (MA). The pilot study was carried out from 2016-2017 with eleven patients (median age 35.5 years) with a migraine with aura.

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The study found that the effect of the pain relief increased significantly with each use of the inhaler. Forty-five per cent experienced an effect the first time, and that number rose to 78 per cent the second time. No adverse events occurred, and side effects were absent or mild.

"The study shows some very significant physiological effects in the body," says Troels Johansen. Together with a team of employees, he has put the inhaler into production through the company BalancAir.

Encouraged with the results the researchers are planning to conduct a large clinical trial that will also include a migraine without an aura and chronic migraine.

For reference log on to http://dx.doi.org/10.1177/0333102418797285