Author: Rapoport Alan M., et al.
Medscape Neurology
Summary
Rapoport and colleagues reviewed evidence on transnasal evaporative cooling as a potential acute treatment for migraine. Two randomized trials have been conducted. CALM 1 tested the CoolStat device but was limited by accrual, with the 6 LPM flow rate showing the most efficacy and no significant adverse events. CALM 2 evaluated the portable Mi-Helper device for at-home use. At the 10 LPM dose, patients had significantly higher 2-hour pain freedom compared with sham, although other endpoints such as sustained pain freedom and 2-hour pain relief did not reach statistical significance. Reported side effects included rhinorrhea, nasal irritation, and jaw pain, but no participants discontinued. The proposed mechanism involves localized cooling of the pterygopalatine fossa and inhibition of the sphenopalatine ganglion and maxillary trigeminal division. CALM 3, a larger phase 3 trial, is ongoing to further evaluate the 10 LPM dose.
Practical implications
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Transnasal evaporative cooling shows early promise for acute migraine treatment, particularly at higher flow rates.
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Device safety profile appears acceptable, with mostly mild, localized adverse effects.
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Confirmation from large phase 3 trials is required before widespread adoption.
References
Author: Rapoport Alan M., et al.
DISCLOSURES, July 21, 2025
Thank you to DISCLOSURES for allowing us to reference this article.