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Original Paper

Eur Neurol 2012;67:288–291 DOI: 10.1159/000335249

Lavender Essential Oil in theTreatment of Migraine Headache:A Placebo-Controlled Clinical Trial

Payam Sasannejad a Morteza Saeedi a Ali Shoeibi a Ali Gorji b Maryam Abbasi a

Mohsen Foroughipour a

a Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad , Iran; b Department of Physiology, Münster University, Münster , Germany

the placebo group (p = 0.001). Conclusion: The present study suggests that inhalation of lavender essential oil may be an effective and safe treatment modality in acute man-agement of migraine headaches.

Copyright © 2012 S. Karger AG, Basel

Introduction

Lavender is a small plant which is native to the Medi-terranean mountains, the Arabian Peninsula and Russia. It is cultivated in Europe, the United States, and parts of Australia [1] . Lavender essential oil is obtained by steam distillation from both the dried flower heads and the aer-ial foliage [2] . Lavender oil was also used by the ancient Egyptians as part of the mummification process [1] . Lav-ender ( ostokhoddous in Persian) was included in The Canon of Medicine by the alchemist and physician Avi-cenna [3] .

Lavender essential oil has been studied recently for several purposes including treatment of mood and anxi-ety disorders [4] , as a sedative [5] , spasmolytic [6] , antihy-pertensive [7] , antimicrobial [8] , antifungal [9] and anti-septic [2] agent, and for precipitation of wound healing [10, 11] . The analgesic effect is one of the widely studied properties of lavender oil [2, 4, 6, 12–14] .

Key Words

Lavender � Migraine � Headache � Acute management

Abstract

Lavender essential oil has been used as an anxiolytic drug, a mood stabilizer, a sedative, spasmolytic, antihypertensive, antimicrobial, analgesic agent as well as a wound healingaccelerator. We have studied for the first time the efficacyof lavender essential oil inhalation for the treatment of mi-graine in a placebo-controlled clinical trial. Methods: Forty-seven patients with definite diagnosis of migraine headache were divided into cases and controls. Cases inhaled lavender essential oil for 15 min, whereas the control group used liq-uid paraffin for the same time period. Patients were askedto record their headache severity and associated symptoms in 30-min intervals for a total of 2 h. We matched the two groups for key confounding factors. Results: The mean re-duction of headache severity in cases was 3.6 8 2.8 based on Visual Analogue Scale score. The reduction was 1.6 8 1.6 in controls. This difference between the controls and cases was statistically significant with p ! 0.0001. From 129 head-ache attacks in cases, 92 responded entirely or partially to lavender. In the control group, 32 out of 68 recorded head-ache attacks responded to placebo. The percentage of re-sponders was significantly higher in the lavender group than

Received: August 29, 2011 Accepted: November 20, 2011 Published online: April 17, 2012

Ali Shoeibi, MD Neurology Group Ghaem Hospital, Ahmad Abad Blvd.Mashhad (Iran) Tel. +98 51 1801 2398, E-Mail shoeibia   @   mums.ac.ir

© 2012 S. Karger AG, Basel0014–3022/12/0675–0288$38.00/0

Accessible online at:www.karger.com/ene

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Lavender Essential Oil in the Treatment of Migraine Headache

Eur Neurol 2012;67:288–291 289

To the best of the authors’ knowledge, there is no doc-umented clinical trial to study lavender for the treatment of migraine. This paper presents for the first time a pla-cebo-controlled clinical trial to evaluate the effects of lav-ender essential oil in the management of migraine head-ache.

Methods

Participants Forty-seven patients with definite diagnosis of migraine head-

ache according to International Headache Society classification of headache disorders [15] were studied in the present single-blind clinical trial. Patients were divided into case and control groups. Thirty-four out of 47 studied patients (72.3%) were females. The mean age of our patients was 30 8 8.5 years.

Material Liquid paraffin was used as the placebo and lavender essential

oil as the drug. The sample of the applied lavender essential oil was analyzed by gas chromatography, and its constituents were reported as: linalool (33.25%), linalyl acetate (35.35%), camphor (17.77%), borneol (4.26%), � -terpinene (0.16%), 1,8-cineol (8.1%), � -pinen (0.13%), � -pinen (0.14%) and limonene (0.26%).

Procedure In the case group (28 subjects), patients were asked to, at the

early signs of headache, rub 2–3 drops of the lavender essential oil onto their upper lip and inhale its vapor for a 15-min period.

Then, they were asked to score the severity of their headache at 30-min intervals up to a total of 2 h according to Visual Analogue Scale (VAS). Severity of headache was defined as no pain (VAS score = 0), mild headache (VAS score = 1–4), moderate (VASscore = 5–6) and severe (VAS = 7–10). In the control group (19 subjects), patients were asked to follow exactly the same proce-dure, except they used drops of liquid paraffin instead. The drug use process was kept the same, and again, the patients were asked to score their headaches in 30-min intervals for 2 h. Headache-associated symptoms such as nausea, vomiting, photophobia, phonophobia and osmophobia, the duration of the headache and quality of headache for each attack were recorded by the patients in special data collection sheets. Response to treatment was de-fined as a reduction of headache severity from moderate or severe to mild or no pain. The data were collected for up to six consecu-tive headache attacks for each patient and were analyzed by the SPSS 15.5 version software. A p value ! 0.05 was considered sta-tistically significant.

At the beginning of the study, cases and controls were matched for the following confounding factors: age, sex, severity of the headache, type and duration of treatment with prophylactic drugs, presence of associated symptoms with headache, the pres-ence of aura, location of headache (unilateral or bilateral), quality of headache (throbbing or non-throbbing), family history of mi-graine, and frequency of attacks ( table 1 ).

The present study was approved by the ethic committee of Mashhad University of Medical Sciences, and all patients signed informed consent. The patients did not know whether they were using the drug (lavender essential oil) or placebo (liquid paraffin). They were instructed not to use any other analgesics during the first 2 h of their attacks.

Table 1. M atched confounding factors in the study

Case Control p value Statistical test

Age, years 3188 2987 0.56 independent sample t test (t = 0.87)Sex, % 0.86 �2 (d.f. = 1)

Male 28.6 26.3Female 71.4 73.7

Headache frequency, per month1 7.687.1 6.384.7 0.82 Mann-WhitneyDuration of headache, h1 12816 17819 0.27 Mann-WhitneyPositive family history for migraine, % 71 74 0.86 �2 (d.f. = 1)Using prophylactic drugs, %1 43 41 0.91 �2 (d.f. = 1)Severity of headache, %1 0.89 �2 (d.f. = 2)

Moderate 36 37Moderate to severe 36 37Severe 28 26

Throbbing quality of headache, %1 96 89 0.35 �2 (d.f. = 1)Photophobia and/or phonophobia, %1 89 94 0.96 �2 (d.f. = 3)Osmophobia, %1 44 41 0.83 �2 (d.f. = 1)Aura, %1 21 23.5 0.57 �2 (d.f. = 1)Unilaterality beginning of headache, %1 61 51 0.18 �2 (d.f. = 1)

1 Before intervention (lavender or paraffin use).

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Sasannejad   /Saeedi   /Shoeibi   /Gorji   /Abbasi   /Foroughipour  

Eur Neurol 2012;67:288–291290

Results

In the case group, there was a significant reduction in the severity of headache in the first to the sixth headache attack after treatment with lavender (p ! 0.001 in all at-tacks, Wilcoxon test). In the control group, the reduction of headache severity was significant after use of placebo in the first to the forth attack, but it was not significant in the fifth and sixth attacks (p = 0.01, 0.002, 0.004, 0.038, 0.15, and 0.1, respectively, Wilcoxon signed rank test).

Unfortunately, not all patients used the drug or pla-cebo for all six attacks. The mean frequency of drug or placebo use was 4.6 8 1.9 for the case group and 3.6 8 1.8 for the control group, and the difference was notstatistically significant (p = 0.08, Mann-Whitney test). Overall, 129 headache attacks with the use of drug and 68 attacks with the use of placebo were recorded in cases and controls, respectively. The mean reduction of headache severity with lavender was 3.6 8 2.8 according to the VAS scoring system. The reduction was 1.6 8 1.6 with place-bo, and this difference between the case and control groups was statistically significant (p ! 0.0001, Mann-Whitney test).

From 129 headache attacks in cases, 92 attacks re-sponded totally or partially to lavender. All responders had total or partial reduction of headache in the first 2 h of the lavender use (5% in the first 30 min of drug use, 20% in the second 30 min, 32% between 1–1.5 h after lavender use and 43% between 1.5–2 h after treatment). In the control group, 32 out of 68 recorded headache at-tacks responded totally or partially to placebo. Eighty-nine percent of responders in the placebo group re-sponded in the first 2 h of treatment. The percent of responders was significantly higher, and the interval between drug/placebo use and headache reduction was significantly lower in the lavender group than the pla-cebo group (p = 0.001 and p ! 0.0001, respectively; � 2 test, d.f. = 1, d.f. = 3).

In the case group, 74% of patients had improvement in their associated symptoms (nausea, vomiting, photopho-bia, phonophobia and osmophobia) after lavender use. In the control group, 58% reported decreased associated symptoms after placebo use. The difference was statisti-cally significant (p ! 0.0001, � 2 test, d.f. = 1). Lavender could prevent spreading of headache from its primary lo-cation in 66% of attacks, whereas placebo could inhibit spreading of headache in only 28% of attacks. This differ-ence was significant (p ! 0.0001, � 2 test, d.f. = 1). Recur-rence of headache (increased headache severity after par-tial or total improvement of initial headache in the first

24 h after treatment) occurred in 5 attacks of responders in the case group. Recurrence was not observed in any responders in the placebo group.

Discussion

The present work reports significant positive effect of lavender oil on the reduction of headache’s severity (mean reduction of 3.6 8 2.8 according to VAS scoring) com-pared to other conventional therapeutic drugs. To bolster the fact that the suggested treatment may actually pro-duce similar, if not better, results, the following literature offers a touchstone for comparison. While 71% of head-ache attacks responded to lavender, Tfelt-Hansen et al. [see 20 ] reported that 70% of headache attacks respond to subcutaneous sumatriptan. Also, a meta-analysis by Fer-rari et al. [16] and Loder [17] showed that 59% of headache attacks respond to oral triptans. In a review article, Lip-ton et al. [18] suggested greater benefit with triptans than with ergotamine compounds in the acute treatment of migraine headache. A randomized clinical trial by Prior et al. [19] confirmed efficacy of acetaminophen 1,000 mg with 52% headache relief at 2 h in migraine patients. A meta-analysis performed by Magis and Schoenen [20] re-ported that aspirin 1,000 mg has similar efficacy as su-matriptan in the management of acute migraine head-ache. Naproxen 500 mg has shown similar effects to oral sumatriptan (100 mg) [21] . It seems that acetaminophen is less potent than aspirin and nonsteroid anti-inflam-matory drugs (NSAIDs; e.g. ibuprofen and naproxen) in acute pain reduction in migraine headaches, and given at a sufficient dose, NSAIDs have an efficacy that is close to oral sumatriptan in the management of acute migraine headache [20] .

Although criteria used for the assessment of headache reduction and treatment are not identical in all these studies, this study shows that lavender may be even supe-rior to oral triptans, acetaminophen, NSAIDs and ergot compounds in symptomatic migraine therapy, and is at least as effective as subcutaneous sumatriptan.

This study shows that, in addition to its analgesic ef-fects, lavender oil can be useful for reduction of symp-toms that are usually associated with migraine headaches (such as photophobia, phonophobia, nausea and vomit-ing). We also showed that lavender oil can prevent spread-ing of headache from primary location. However, treat-ment with lavender may increase the risk of headache re-currence.

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Lavender Essential Oil in the Treatment of Migraine Headache

Eur Neurol 2012;67:288–291 291

Based on the reported findings and the fact that laven-der oil has no significant side effects other than prepu-bertal gynecomastia in cases of repeated exposures [2, 22] , we suggest that inhalation of lavender essential oil may be an effective and safe treatment modality in acute

management of migraine headaches. Further clinical tri-als for direct comparison between lavender and other drugs which are routinely used for symptomatic therapy of migraine (such as acetaminophen, NSAIDs, triptans and ergot compounds) are recommended.

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