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Study flow diagram.
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Figure 1

Study flow diagram.

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'Risk of bias' graph: each 'Risk of bias' item presented as percentages across all included studies.
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Figure 2

'Risk of bias' graph: each 'Risk of bias' item presented as percentages across all included studies.

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'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study.
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Figure 3

'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study.

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Forest plot of comparison: 1 HBOT versus control for acute migraine attack, outcome: 1.1 Substantial acute relief of headache.
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Figure 4

Forest plot of comparison: 1 HBOT versus control for acute migraine attack, outcome: 1.1 Substantial acute relief of headache.

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Comparison 1 HBOT versus control for acute migraine attack, Outcome 1 Substantial acute relief of headache.
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Analysis 1.1

Comparison 1 HBOT versus control for acute migraine attack, Outcome 1 Substantial acute relief of headache.

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Summary of findings for the main comparison. Hyperbaric oxygen therapy for acute migraine

Hyperbaric oxygen therapy for the relief of acute migraine

Patient or population: Acute migraine
Setting: Hospital care
Intervention: HBOT (2.0 to 2.4 ATA for 40 to 45 minutes)
Comparison: Sham therapy (air at pressure or 100% oxygen at 1 ATA)

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(trials)

Quality of the evidence
(GRADE)

Comments

Risk with sham therapy

Risk with HBOT

Chance of obtaining substantial headache relief (Relief).
Assessed with: Patient self‐assessment

Study population

RR 6.21
(2.41 to 16.00)

58
(3 RCTs)

Low¹

We included 3 small RCTs but all showed large effect size with HBOT compared to either air or 100% oxygen sham.

111 per 1000

663 per 1000
(162 to 1000)

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Abbreviations: CI: confidence interval; RR: risk ratio; OR: odds ratio; ATA: atmospheres absolute; HBOT: hyperbaric oxygen therapy.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

¹The evidence has been downgraded from moderate to low due to two of these trials being incompletely reported crossover trials reported only in abstract. [Two of the three included studies were planned as crossover trials. In those two, many patients obtained relief during the first treatment period and were not crossed to the second period. For Hill 1992, where all patients are not clearly accounted for we have included the results only from the first treatment period.]

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Summary of findings for the main comparison. Hyperbaric oxygen therapy for acute migraine
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Comparison 1. HBOT versus control for acute migraine attack

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Substantial acute relief of headache Show forest plot

3

58

Risk Ratio (M‐H, Fixed, 95% CI)

6.21 [2.41, 16.00]

1.1 HBOT versus air sham therapy

2

38

Risk Ratio (M‐H, Fixed, 95% CI)

5.28 [1.76, 15.87]

1.2 HBOT versus 100% oxygen at 1 ATA

1

20

Risk Ratio (M‐H, Fixed, 95% CI)

9.0 [1.39, 58.44]
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Comparison 1. HBOT versus control for acute migraine attack
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