 High Oxygen Flow Rates for Cluster Headache
Frequently
Asked Questions
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High
Oxygen Flow Rates for Cluster Headache
(by Todd
D. Rozen, M.D.)
Use of oxygen therapy in cluster headache
patients
Cluster headache patients require effective abortive therapy due to the extreme
intensity of their pain. The two most effective cluster abortives are injectable
sumatriptan and inhaled oxygen. However, since a large percentage of cluster sufferers
are cigarette smokers and at high risk of coronary artery
disease, many cannot be treated with the various triptan medications. In these cases, oxygen therapy becomes
the preferred option.
Oxygen, the safest of all cluster therapies, is usually prescribed based on a landmark
study by Dr. Lee Kudrow. In this study, patients
were instructed to use 100% oxygen
via a nonrebreather face mask at 7-10 liters/minute. Although usually effective,
a certain subset of cluster patients do not achieve relief from this treatment.
Todd Rozen, MD, of MHNI hypothesized that treating patients with higher flow rates
of oxygen, up to 15 liters/minute, might provide relief to those sufferers who had
not responded to standard oxygen therapy regimens.
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High oxygen flow rates
Because MHNI has many intractable cluster patients, it was decided that a higher
dose of oxygen therapy would be utilized in a few patients. Several important cases
recently reported in the medical literature found this therapy to be quite effective
in patients who previously did not respond to lower dose oxygen inhalation.
MHNI's experience indicates patients who do not respond to standard flow rates should
be
given the opportunity to use up to 15 liters/minute. However, prior to initiating
this therapy, patients must obtain clearance from their primary care physician since
serious lung disease or other conditions can make oxygen therapy unsafe or inappropriate.
In addition, such oxygen therapy should not be used for more than a maximum of 10-20
minutes at a single setting.
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Conclusion
The basis by which oxygen turns off a cluster headache is unknown at this time.
Oxygen's constrictive effect on cerebral blood vessels may play a significant role.
Further study and a larger sample size is needed to provide conclusive evidence
regarding the usefulness of high oxygen flow rates for difficult-to-treat cluster
headache patients.
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