EPP530
Intranasal Air Suction Approach for Management of Acute Migraine Headache: An International Perspective
J. Jeyapalan 1 2,*, M. Nissila 3, S. Sihvonen 1
1School of Health and Social Studies, Jyväskylä University of Applied Sciences, Jyväskylä , 2Department of Psychiatry, University of Turku, 3clinical Research and Biobank, Suomen Terveystalo, Turku, Finland
Introduction:
Migraine is a disabling neurological disorder affecting over one billion people worldwide. Despite advances in treatment, the precise mechanisms remain unclear. The Sinus Hypoxic Nitric Oxide Theory (SHNOT) suggests that excessive sinus nitric oxide (sNO), generated under hypoxic conditions, plays a central role in migraine pathophysiology.
Objectives:
This study aimed to evaluate and compare two nasal-based interventions—intranasal drug administration (INDAA) and paranasal air suction approach (PNASA)—for acute migraine management. Specific objectives were to:
1) Assess their efficacy in rapid symptom relief,
2) Compare safety and side-effect profiles,
3) Examine the mechanistic role of sNO and sCO,
4) Validate SHNOT as a theoretical framework.
Methods:
An integrative review was conducted. Literature searches in PubMed, Google Scholar, and Cochrane identified 312 records. After screening, 11 studies met the inclusion criteria. Thematic analysis was applied across randomised trials, case series, meta-analyses, and gas analysis studies.
Results:
INDAA agents (zolmitriptan, lidocaine, hydroxocobalamin, oxymetazoline) showed variable efficacy, often accompanied by local irritation or systemic effects. In contrast, PNASA studies consistently demonstrated rapid migraine relief within 1–2 minutes, with no adverse effects reported (Figure 1).
Table 1 summarises key outcomes.
Intervention |
N (participants) |
Onset of Relief |
Adverse Effects |
|
Zolmitriptan (5 mg nasal spray) |
798 |
≤2 h |
Mild systemic effects |
|
Intranasal Lidocaine |
134 (meta-analysis) |
≤5 min |
Local irritation (~49%) |
|
Hydroxocobalamin (1 mg intranasal) |
20 |
Prophylactic (3 mo) |
Well tolerated |
|
Oxymetazoline (0.1%) |
108 |
≤15 min |
Potential rebound congestion |
|
PNASA (air suction) |
184 |
1–2 min |
None observed |
Image 1:
Conclusions:
Paranasal air suction represents a safe, non-invasive, and cost-effective acute migraine treatment. Findings strongly support SHNOT, positioning sNO as a key causative molecule. PNASA shows superior efficacy and tolerability compared to INDAA, highlighting its potential as a first-line intervention in diverse healthcare settings.
Disclosure of Interest: None Declared