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General

Rehaler is a drug free device for treatment of migraine med aura. Rehaler is developed by the Danish company BalancAir which was founded in 2009 with the goal of making CO2 treatment practical and widely available.

Rehaler’s effect is achieved by increasing the CO2 level in the inhalation air while ensuring that the user gets enough oxygen. Rehaler does not use gas cylinders to achieve this effect, but instead uses part of the CO2 that the body produces – mixed with fresh air in a carefully and individually measured ratio. By utilizing this principle, Rehaler is the first device that, in a practical and safe way, makes it possible to treat migraines using CO2. As Rehaler uses the body’s own CO2 supply, it does not run (like gas bottles) dry or needs refilling, and because of its small size and weight it can easily be stored in a pocket or bag. Since Rehaler constantly supplies a carefully controlled, stable amount of fresh air, oxygen does not run out during use, so Rehaler can be used for as long as needed, without risk to the user. In this way, Rehaler provides the user with the precise levels of oxygen and CO2 that are optimal for stopping migraine attacks. Rehaler is effective for as long as it is used, but clinical trials have shown that in many cases it is enough to use it 10-20 minutes at the start of a migraine attack to prevent the attack. Rehaler can be used as an alternative to medication, but because the treatment itself is medication-free it is also possible to use it with normal migraine medication. Rehaler is drug-free, so there is no limit to how long or how early a migraine attack can be treated. This is a major benefit in terms of common migraine medication (Sumatriptan, Imigran, Relpax, Maxalt, Panodil, Ipren, Kodimagnyl, etc.) which has an upper limit on how often and how many times in a month you can treat (which therefore many migraine patients have to wait until relatively late in the course of the seizure to take their medication).

Rehaler consists of 4 parts:

  • Disposable inhalers that you breathe through and make sure you have the right balance of CO2 and oxygen.
  • Control device that you put on your finger and that makes sure you always have enough oxygen in your blood.
  • Nose clip that makes sure all the air you get into the body goes through the inhaler.
  • Treatment app that helps you configure Rehaler and guides you to use it optimally

Rehaler is used as soon as you notice an attack on the way. You take the control unit on your finger, the nose clip on the nose and begin to breathe through the inhaler. If you need it you will also be able to open the treatment app and it will guide you through the use. Then breathe through the inhaler for approx. 15-20 minutes or longer if you keep having symptoms after which the treatment is over and hopefully you have been able to feel that the migraine attack has stopped or the pain has been reduced. Subsequently, the app will ask you a number of questions about your use as well as what effect you achieved. The app will use your responses to calculate a more optimal use of Rehaler which includes change in inhaler setting, processing time and the like. This feedback will be presented to you and will always be available through the app so you know how to use the equipment the next time you have a seizure.

As a general rule, while using Rehaler, sit down or lie with a pillow in the back, in a relaxed position. You do not need to control your breathing in any particular way, and if you want, you may well read or watch TV while using Rehaler, but do not exercise or sleep while. Because you have the inhaler in your mouth when you use it, you may not be able to talk easily, but if you need to give a brief message, there is nothing in the way of taking it out of your mouth for a short time.

Rehaler is medication-free and you can therefore use it with other migraine and over-the-counter medicines.

Yes. The Rehaler app is important in the configuration of the equipment, as well as helping you to get the optimal treatment, get advice and guidance etc. on an ongoing basis.

Effect & Science

Yes, the Rehaler treatment was tested from 2016 to 2017 in a randomized, controlled and double blind clinical trial at Aarhus University Hospital. You can read more about the results here. We are currently working on initiating another larger clinical trial with many different migraine types.

A number of studies indicate that many migraine attacks start because the brain’s blood vessels contract and the blood therefore cannot supply the brain with enough oxygen. When the brain lacks oxygen the result for migraine patients is a domino effect called Cortical Spreading Depression. It is a slow, very destructive “wave” which spreads through the brain’s nerve cells and eventually leads the actual migraine attack’s pain, nausea, light/sound sensitivity and lethargy. When you increase the CO2 level in the body by using the Rehaler, within ten seconds a number of well-documented affects occur which counteract the development of migraine attacks:

  1. The supply of oxygen and blood-sugar to the brain increases significantly because the brain’s blood supply increases. The counteracts the contraction of the brain’s blood vessels and increases oxygen supply to the brain by over 50%. When you use CO2 to increase the blood supply to the brain it is crucial to retain a normal oxygen saturation in the blood, which is why Rehaler is carefully balanced to ensure both CO2 levels and oxygen saturation are high.
  2. Susceptibility of the body’s nerve cells is significantly decreased. This is an important affect in migraines because attacks are more easily triggered, developed and worsened during periods where nerve cells are very sensitive and impressionable.

Together these affects make it possible to inhibit Cortical Spreading Depression in the crucial early phase of the migraine attack and thereby significantly limit the attack’s severity.

Migraine patients and migraine attacks are very different. Therefore all types of migraine treatment (including drugs) vary in their affect from person to person, and sometimes from attack to attack. In the clinical trial and subsequently among 50 test users it became apparent that Rehaler works for many but not all migraine attacks. Many patients experience that by using Rehaler early on in the migraine’s development they are able to completely avoid the attack, others experience a reduction of the symptoms, while a minority have no affect. The affect depends on many conditions, some of which are in the user’s sphere of control and others that aren’t. We recommend that you fill out our online migraine questionnaire to determine if Rehaler is a good match for you. To achieve the best effect of the treatment it is important to begin early in migraine process, preferably when the first warning signs of an attack reveal themselves.

The Rehaler treatment has so far exclusively been tested on migraines with aura and there is therefore little knowledge of the effect on migraines without aura. Using Rehaler is not harmful, you should therefore be able to try Rehaler even if you don’t have aura, however as stated we cannot guarantee an effect. To explore the effect on other migraine types we are currently working on initiating a clinical trial with treatment af among others chronic migraine and migraine without aura. 

30 years ago it was believed a migraine occurred when blood vessels expanded in the brain. This was a natural assumption since the pain felt throbbing or pulsating. This throbbing was thought to originate from the pulse beats. Brain scans have shown that its actually the other way around. Blood vessels on the exterior of the cranium often expand during an attack, while the blood vessels in the brain contract. The contraction happens before and in some instances far into to pain phase. Other studies have shown that an expansion of the blood vessels (e.g. by using specific medication) does not on its own initiate a migraine attack. More over it has been proven that there is no connection between pulse beats and the throbbing sensation. The theory that migraines were caused by an expansion of the blood vessels has therefore been refuted. There still exists many websites that haven’t updated their knowledge of migraines, so they do reflect the science from past decades. It has been demonstrated that blood vessel contractions are a much more important trigger among many migraine patients.

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