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Topical menthol 10% solution (peppermint oil) may abort acute migraine

Clinical Question:
Is topical menthol 10% solution effective as an abortive treatment of acute migraine headache in adults?

Bottom Line:
Topical menthol 10% solution applied as described below may be more effective than placebo solution in alleviating acute migraine headache pain in adults.?Topical menthol 10% solution applied as described below may be more effective than placebo solution?? There?s a typo in Table 2 ? the n for migraine attacks in the placebo group should be 58, not 8. (LOE = 2b)

Reference:
Haghighi AB, Motazedian S, Rezaii R, et al. Cutaneous application of menthol 10% solution as an abortive treatment of migraine without aura: A randomised, double-blind, placebo-controlled, crossed-over study. Int J Clin Pract 2010:64(4):451-456.

Study Design:
Cross-over trial (randomized)

Allocation:
Concealed

Setting:
Outpatient (specialty)

Synopsis:
These investigators identified 44 adults, aged 18 to 65 years, who met standard international criteria for migraine headache and had at least a 1-year history of migraines and 1 to 6 migraine attacks per month. Eligible patients randomly received (concealed allocation assignment) either menthol for the first 2 of 4 migraine atttacks followed by placebo for the second 2 attacks, or the same treatment in the opposite order. Patients and all investigators who assessed outcomes remained masked to treatment order. Active study medication was prepared as a 10% solution of menthol crystals in ethanol. A solution of 0.5% ethanol menthol solution with the same color and odor served as the placebo. At the onset of a migraine, patients intitially cleansed the forehead and temporal area of the most painful side of the head with tap water. After drying, 1 mL of active drug or placebo was applied with a sponge on a surface area of 5 cm x 5 cm. The same treatment was reapplied after 30 minutes. Participants were allowed to take rescue medication if needed after 2 hours. Follow-up occurred for 79% of patients for 4 migraine attacks. Patients reported no pain at 2 hours after attacks significantly more often when treated with menthol 10% than when treated with placebo (38.3% vs 12.1%; number needed to treat [NNT] = 4; 95% CI, 2.5-9.4). Similarly, patients reported a greater than 50% decrease in pain scores compared with baseline significantly more often when treated with menthol 10% than with placebo (58.3% vs 17.2%; NNT = 2.4; 2-4). No recurrence of headache at 24 hours also occurred signifcantly more often in patients when using menthol 10% than when using placebo (33.3% vs 12.1%; NNT = 5; 3-17). Two patients (5.7%) dropped out of the trial because of a severe burning sensation on the temporal area and an aggravation of headache.

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