Intranasal Air Suction Approach for Management of Acute Migraine Headache: An International Perspective
J. Jeyapalan, M. Nissila, S. SihvonenIntroduction
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:
Assess their efficacy in rapid symptom relief, Compare safety and side-effect profiles, Examine the mechanistic role of sNO and sCO, 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).
summarises key outcomes Table 1. Long description.