Can You Use Intranasal Cooling for Migraines at Home?
No, it’s not practical. This feasibility study found that at-home intranasal cooling caused too much pain and discomfort, leading to high dropout rates. Only 6 out of 15 participants completed the study, and the treatment was rated as “very unpleasant.”
A previous pilot study showed that intranasal evaporative cooling could help migraines when given in a clinic. But for this treatment to be useful for most migraine sufferers, people need to be able to use it at home. This study tested whether that’s realistic. The results were disappointing.
What the Data Show
- Dropout rate: Only 6 out of 15 participants (40%) completed all three treatments
- Main reasons for dropping out: Pain and discomfort from the treatment, plus lack of effect
- Tolerability score: 7.3 out of 10 on the “unpleasant” scale
- Total treatments completed: 23 treatments by 10 participants
- Pain relief: Small effects on pain immediately after treatment
- Comparison to usual care: Treatment was not superior to participants’ usual migraine medications
- Study outcome: The planned large-scale trial was cancelled
Dr. Kumar’s Take
This is a cautionary tale about the gap between clinic-based research and real-world use. The earlier pilot study showed promise when nurses administered the treatment. But when patients tried it at home, the nasal discomfort was too much. The cold spray in the nose was so unpleasant that most people quit. I appreciate that researchers had the integrity to publish these negative results and cancel their planned larger trial. This saves other researchers and patients from pursuing a dead end.
Why It Didn’t Work at Home
The treatment involved inserting a silicon catheter into each nostril and spraying a cooling mist toward the base of the skull. In a clinic, trained staff could help guide patients through discomfort. At home, people were on their own.
The cooling spray lowered nasal temperature by about 2°C. While this cooling mechanism makes sense for pain relief, the actual experience was too uncomfortable. Participants described the treatment as very unpleasant. The discomfort outweighed any migraine relief.
The Study Design
Researchers in Sweden recruited 15 adults with episodic migraine. After a screening period where they tracked two migraine attacks with their usual care, participants were asked to treat their next three migraines at home with 10 minutes of intranasal cooling using the RhinoChill device.
Researchers measured headache, nausea, light sensitivity, and sound sensitivity immediately after treatment and at 1, 2, and 24 hours.
Important Limitations
This study had several challenges:
- Small sample size due to slow recruitment
- High dropout rate meant limited data
- No placebo comparison group
- Participants knew they were receiving the real treatment
- Recruitment occurred during the COVID-19 pandemic, which may have affected participation
Practical Takeaways
- Intranasal cooling is not currently practical for home use
- The treatment causes significant nasal discomfort
- Standard cold applications (ice packs on forehead or neck) may be better options
- Work with your doctor to find effective migraine treatments
- Clinical treatments don’t always translate to home use
Related Studies and Research
- Related Podcast Episode
- Cold water immersion: kill or cure? (review PDF)
- Cold-water immersion changes brain network connectivity (fMRI study)
- IMMUNE AND INFLAMMATION (MECHANISTIC + HUMAN ADAPTATION)
- Intranasal evaporative cooling for acute migraine (pilot)
FAQs
Why did the earlier pilot study show better results?
The earlier pilot study was done in a clinic with 20 treatments in 15 patients. Staff could help patients through discomfort. At home, people were alone and more likely to stop when it hurt.
Is intranasal cooling still being studied?
This study’s negative results led researchers to cancel their planned large-scale trial. The treatment in its current form is unlikely to become widely available for home migraine treatment.
Are there other cold treatments for migraines?
Yes. Ice packs on the forehead, temples, or back of the neck are the most common self-administered cold treatments for migraines. These are much simpler and better tolerated than intranasal cooling.
Bottom Line
This Swedish feasibility study found that intranasal evaporative cooling for migraines is not practical for home use. Most participants dropped out because the treatment was too painful and uncomfortable. The treatment was rated as very unpleasant (7.3 out of 10) and was not better than usual care. Researchers cancelled their planned large-scale trial based on these results. While cold therapy remains a valid approach for migraine relief, spraying cooling mist into the nose is not a user-friendly delivery method.
