Two types of oxygen therapy could offer some relief to adults who suffer from disabling migraine and cluster headaches, according to a new research review from Australia.

Migraine headaches are severely painful and usually occur with other symptoms such as nausea, vomiting and painful sensitivity to light. Cluster headaches cause sharp, burning pain on one side of the head.

Physicians commonly rely on a number of drug therapies to both treat and prevent migraine and cluster headaches, but some also prescribe oxygen therapy. The aim of the systematic review — comprising nine small studies involving 201 participants — was to determine whether inhaling oxygen actually helps.

“We wanted to locate and assess any evidence from randomized trials that oxygen administration was a safe and effective treatment for migraine or cluster headaches,” said lead reviewer Michael Bennett, of Diving and Hyperbaric Medicine at Prince of Wales Hospital in Sydney. “We hoped this would assist physicians to make effective treatment decisions in this area.”

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

The Cochrane reviewers examined studies that evaluated normobaric oxygen therapy and hyperbaric oxygen therapy. Normobaric therapy consists of patients inhaling pure oxygen at normal room pressure, and hyperbaric therapy involves patients breathing oxygen at higher pressure in a specially designed chamber.

Five studies compared hyperbaric versus sham (placebo) therapy for migraine; two compared hyperbaric versus sham therapy for cluster headache; and two investigated the use of normobaric therapy for cluster headache. Length of treatment varied with each study.

Three studies reported the number of patients who had significant relief from their migraines within 40 to 45 minutes of hyperbaric therapy. Although the studies did not specify each patients’ response to treatment, they reported a significant increase in the proportion of patients who had relief with hyperbaric oxygen compared to sham therapy.

For cluster headaches, two studies (69 patients) found a significantly greater proportion of patients had relief of their headaches after 15 minutes of normobaric compared to sham therapy.

The reviewers concluded that hyperbaric treatment might give some relief for migraine headache and that normobaric therapy might provide similar relief for cluster headache, but there is no evidence that these therapies will prevent future attacks.

“We believe that hyperbaric oxygen is also a reasonable measure for migraineurs who have not responded to other measures to treat an acute attack,” Bennett said. “However, the poor availability of hyperbaric chambers makes this an option only in a minority of health facilities. Most physicians treating headaches will continue to rely on established and emerging pharmacological options for treating and preventing acute attacks.”

Estimates indicate that 6 percent to 7 percent of men and 15 percent to 18 percent of women suffer from severe migraine headaches, and cluster headaches effect about 0.2 percent of the population.

John Kirchner, M.D., of the Kirchner Headache Clinic in Omaha, Neb., has treated thousands of patients suffering from a variety of headaches, including migraine and cluster, and said he does not include oxygen therapy in his patients’ treatment plans.

“This [oxygen therapy] would not be practical as the headache comes on fast and does not last long,” he said. “So there would not be time to get the patient to the chamber.”

Kirchner’s treatment for migraine includes avoiding triggers, taking preventive and symptomatic medications and undergoing behavior modification.

Bennett MH, et al. Normobaric and hyperbaric oxygen therapy for migraine and cluster headache. Cochrane Database of Systematic Reviews 2008, Issue 3.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

For premenopausal women, the decision of whether to undergo a hysterectomy —removal of the uterus — is a challenging one. To make things more complex, added pressure to decide whether to remove the ovaries can arise — a decision that researchers say relies more on the preferences of the woman or her surgeon than on evidence-based medicine.

Prophylactic oophorectomy is the medical term for removal of healthy ovaries to prevent the potential risk of developing ovarian cancer later in life.

“Prophylactic oophorectomy is performed across the world on the basis of very limited evidence,” said lead review author Leonardo Orozco, M.D., an attending OB/GYN at Women’s Hospital San José in Costa Rica. “Questioning this practice is a crucial step in advancing our ability to make decisions that may ultimately improve the health and well-being of women.”

However, of the 119 studies that the researchers identified, only one controlled clinical trial met the review’s inclusion criteria — and it was not particularly strong.

“After our search, we were able to find only one clinical control trial of low-quality that has been used to justify such a high number of prophylactic oophorectomies every year,” Orozco said.

That single study included 362 women, who were ages 45 to 55 years when it began. Of those, 217 underwent hysterectomy alone and 106 underwent hysterectomy plus oophorectomy. The study looked at the average changes in psychological well-being and sexuality, both before and one year following the surgery.

Despite the study’s limitations, Orozco says the review’s results are worth noting. “For me, the most important result of this research was to raise the awareness that, as physicians, we must always question why we are performing a specific procedure. We cannot always rely on training, as there are ‘habitual’ procedures that we undertake, which may not be the best evidence-based decision.”

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

“This is an almost impossible area to research insofar as a prospective, randomized, double-blind controlled trial is totally impossible,” said Mary Jane Minkin, M.D., a clinical professor of OB/GYN at Yale University School of Medicine. Therefore, she said, “This is one area where individualization of care is absolutely necessary.”

In the context of few studies to justify a choice either way, Minkin says she tells her patients “that it is their decision, as long as the ovaries are healthy.”

“But,” she adds, “it takes a lot of informed consent to help them make this decision and many docs do not take the time to go through this lengthy decision-making process.” With patients going from one HMO to another, doctors do not really get a chance to know these women really well, “and it becomes that much more difficult to make an informed decision,” she says.

The study analyzed in the review included premenopausal women who underwent hysterectomy for benign gynecological conditions. The reviewers excluded all studies where the women had gynecological cancer, were postmenopausal, or both — as defined by the original study authors.

Both Orozco and Minkin acknowledge that myriad factors go into the decision to remove the ovaries. For example, “We know that women who undergo early menopause, either medically, or particularly surgically [after removal of the ovaries], are at very high risk for cardiovascular disease and osteoporosis,” Minkin says. “If they are not given estrogen therapy, estimates in some papers are as high as a seven-fold risk of cardiovascular disease. There is a reduction in risk of breast cancer, to be sure, but the other diseases are substantially increased.”

Orozco adds that it is important to consider the long-term implications of ovary removal — some of which remain unclear. For example, even after menopause, the ovaries produce significant amounts of certain hormones that other tissues convert to estrogen. “Therefore,” he says, “there could be underlying advantages of ovarian function … that may mean that removal of the ovaries has clinically significant consequences.”

“The conclusions of this review are limited by the lack of data,” Orozco says. “However, it demonstrated that more research of higher methodological quality is needed in order to justify an intervention that we still don’t know is beneficial or harmful.”

Orozco LJ, et al. Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women. The Cochrane Database of Systematic Reviews 2008, Issue 3.

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Compared to their victims, bullies experience a significantly higher risk of a wide range of health, safety and educational problems, according to research in the International Journal of Adolescent Medicine and Health.

“We see that the [obvious] victims are not the only victims. The bullies are also victims of their own emotional problems,” said lead study author Jorge Srabstein, M.D., medical director of the Clinic for Health Problems Related to Bullying at Children’s National Medical Center in Washington, D.C.

He and his coauthor analyzed data from a 1996 survey of 9,574 students in grades 6 through 10. Students noted their involvement in bullying in the last year, but also identified whether they had participated in a variety of risky behaviors.

More than one-third (39 percent) of students reported some involvement in bullying within the preceding 12 months, either as bullies, victims or both.

“Both the bullies and the victims have a very significant, high probability of suffering from injuries — self-inflicted, accidental and injuries that are perpetrated by others — as compared to those who are not involved in bullying incidents. Because of this, they are at a considerable danger of dying from suicide, homicide and accidents,” Srabstein said.

In this study, victims proved more likely to inflict self-injury or experience accidental injuries, abuse over-the-counter medications, hurt animals and people on purpose, use weapons and be absent from school, compared to uninvolved students.

However, the survey also revealed that bullies and bully/victims — students who have both bullied and been bullied — experienced an even greater risk of these problems than victims. Bullies and bully/victims were more likely — with up to a 14-fold increased risk — to abuse alcohol, drugs and tobacco; experience injuries requiring hospitalization; set fires; carry weapons to school; skip classes; and receive poor grades, compared to victims alone.

The authors’ findings about the prevalence of bullying are in line with other large studies from the United States and around the world, said Rachel Vreeman, M.D., a fellow in children’s health services research at Indiana University School of Medicine. She had no connection to the study.

“Bullying occurs among children in every part of the world where it has been studied. The amount of bullying has not changed in recent years. Instead, more people identify bullying as a problem among children, look for bullying and look for ways to prevent it,” Vreeman said.

“While being involved in bullying is associated or tied with some scary things like hurting others, using weapons and abusing medicines, this does not mean that one causes the other. They go together in these groups of kids, but this type of study cannot tell us that being bullied or being a bully means that you will do these types of things,” she said.

Ultimately, the research highlights bullying as a public health issue for both educators and health care practitioners, Srabstein said. Both “bullies and victims need to be referred for health care if their participation is accompanied by problems like this,” he said.

The International Journal of Adolescent Medicine and Health, is a peer-reviewed journal based in Jerusalem. Visit http://www.freundpublishing.com/International_Journal_Adolescent_Medicine_Health/adol20_2.pdf

Srabstein J, Piazza T. Public health, safety and educational risks associated with bullying behaviors in American adolescents. Int J Adolesc Med Health 20(2), 2008.