Welcome to O2 - THIS WORKS!! 

***US Cluster Headache Survey Data Available*** 

Provided below for your reference is the initial research submission and two abstracts from the U.S. cluster headache survey co-authored by Dr. Todd Rozen of Geisinger Medical Center and Royce Fishman of Linde Healthcare, Linde Gas, and presented at the 2009 International Headache Congress September 2009. These are the first publications of the large on-line survey 1,134 cluster headache sufferers participated in and which involved efforts and support by OUCH, Clusterheadaches.com, the American Headache Society and others. These are excellent educational tools for your physician and insurance provider.

There are plans for Dr. Rozen and Royce Fishman to develop and submit as co-authors several full length articles to medical journals based on the large volume of survey data.  This series of articles, like the abstracts, will help to educate sufferers, physicians and insurers about cluster headache based on your direct input versus long held assumptions.

Right click to save the following .pdf files to your computer:

Initial oxygen study results.pdf - NEW!

Rozen and Fishman final r4 CH survey general abstract IHC 2009.pdf

Rozen and Fishman final r4 CH survey O2 focused abstract IHC 2009.pdf

***US Cluster Headache Survey Data Available***  

An incredible amount of effort has been put into making this page possible.  I would like to thank all of those involved, particularly, ClusterChuck, who put this information together through his many years of "experience" in dealing with the beast we refer to as Cluster Headaches.

The information below is meant to give cluster headache sufferers the basic knowledge required to abort an attack with 100% oxygen.  It is in no way and "all inclusive" guide to oxygen therapy, but will hopefully give sufferers, new to the treatment, a "head start" in easing their pain.  With that being said... here is Chuck's information:

Oxygen treatment has been proven to be a safe, effective, and relatively inexpensive method to abort a cluster headache attack for many sufferers. Some people do not respond to this treatment, just as some do not respond to the many drugs prescribed. There are many reasons for this, including improper usage.

Members of this community are not doctors, but we know what works for us and we are trying to give you good information and tools that you may use to help with your pain. You and your physician are ultimately responsible for your own care and the owner of this board cannot be held liable for use and/or misuse of the information provided. There is a wealth of information on this forum and you are encouraged to read it all. We are all looking for a "Cure"-not just a bandage to this debilitating condition-unfortunately, oxygen treatment is "only" a bandage. But it IS an effective one when used CORRECTLY. Good luck!

The benefits of oxygen therapy for sufferers of CH are clearly documented and can be a great help in diminishing the horrible effect of this malady. It is important to start the therapy at the very first sign of an onset of the headache, the sooner, the better. If you wait, you will suffer more.

Proper Delivery System

  • Oxygen supply (tank of oxygen--preferably medical grade)

    • In the USA, it is necessary to have a prescription from your doctor to use oxygen.
  • A Regulator

    • Regulates the flow of oxygen out of the tank.  Needs to be capable of delivering oxygen up to at least 15 liters per minute.  10-12LPM is sometimes enough but less will not be as effective.  Higher rates can sometimes be even better, such as 25-60 LPM.

  • A NON-REBREATHER mask- (such as the ClusterO2 Kit ) a type that covers your mouth and nose and has a bag below to conserve the pure oxygen (NOT the tubes that go into your nostrils!).

    • The amount of time to breathe the oxygen is important.  If you do not get relief in 15-20 minutes of treatment, you will probably not get relief for that headache by further use. Sometimes, waiting 10 minutes, and then trying again, works.

    • Cut off any elastic band that will hold the mask onto your face--if you fall asleep with the mask attached, you may suffocate if the oxygen supply runs out.

  • Demand Valve System (optional, but HIGHLY recommended)

    • More expensive, but highly effective.  A special valve that incorporates the use of an additional fitting on a regulator to provide an un-interrupted flow of oxygen when needed.  The oxygen flow shuts off when you are not actively breathing through the mask, optimizing the tank.

  • A "Bubbler" Bottle (optional)

    • Adds moisture to the oxygen will help your sinuses and throat from dryness and irritation. If you are ordering from a catalog or medical supply place, it is called a disposable humidifier. (Cannot be used with Demand Valve System)


  • You must have a place that has NO open flames- NO SMOKING cigarettes, NO candles, NO fire! Oxygen can saturate your clothing, bed sheets, etc. and then catch on fire when you light a match. Be very careful and wait at least 30 minutes after using oxygen before smoking.



Here are terms that you will see used, when talking about Oxygen treatment.

Flow Rate:  This is the term used to describe how fast, or how much oxygen is delivered to the mask.  It is rated in “LPM” which means Liter(s) Per Minute.  We need a flow rate of at least 15 LPM.  The flow rate is controlled by the regulator, not the tank or mask.

Cylinder/tank/bottle:  This is the container that the oxygen comes in.  There are many sizes.  The most common are the "E" tank and the "M" tank.  The "E" tank is the one we use to cart around with us.  It is about 30" tall, 4 1/2" in diameter, and weighs about 8 pounds.  The "M" tank is WAY too big to cart around, but is the one we keep in our house, for the home hits.  It is about 4' tall, 7" in diameter and weighs about 70 pounds.  The two tanks I have mentioned are just two of many sizes, but they are two different types of regulator hook ups that I will explain below.

Common oxygen tank information

Tank Pressure
Nom. OD
Nom. Lgth
Nom. Wt.
Empty (lbs)
H 2015 251 9.04 51.00 130
M 2015 125 7.00 43.00 75
E 2015 20 4.14 25.75 16
D 2015 10 4.14 16.75 10

On the top of each tank there is a stem, or valve, to which you connect your regulator, AND for turning the flow on or off.

“E” tank stem/valve

“M” tank stem/valve
Regulator:  This is a device that you connect to your oxygen tank, and then you connect your hose (to your mask).  This is the device that controls the flow rate.  For our use, we want a regulator that can go to AT LEAST 15 LPM, higher is actually better, but 15 LPM is a must!  You do NOT need a prescription in order to buy a regulator.  They can be found on the net, and most of us buy them from eBay.

The green regulator is for the “E” tank, and the silver one is for the “M” tank.


Note - On the green “E” tank regulator, notice the plastic wrench that I have attached with a piece of chain, that is used to turn the tank on and off.

Regulator Types:  There are many, MANY different styles and types of regulators.  What we clusterheads are interested in are the ones that have a flow rate of at least 15 LPM.  We also need to know what type of tank it is to go on.  From the pictures above, you can see that there is a big difference in the means to connect the regulator to the tank.

“E” tank yolk on the regulator (Hand connection – no tools required)

“M” tank sleeve, or nut to connect to the tank. (Wrench needed)


Standard non-rebreather mask  (VERY inexpensive)


Non-rebreather Mask:
This is a mask that fits over your mouth and nose, with a bag attached to collect the oxygen for the next inhalation.  There are little valves that prevent the exhaled air from getting into the bag.  There are also little valves on the outside of the mask that allows the exhaled air to vent, yet closing during an inhalation.

Notice the little round white disks on the side of the mask.  These control the exhaled air, and the outside air.  If there is not one on each side, either tape over the other one, or (as I do) place your thumb over the holes, during an inhalation, and then remove the thumb during an exhalation.  If these valves are not present, or in good flexible condition, you will not get the full 100% oxygen that is required.

If you are male, and have facial hair, you may have trouble getting a full seal around the mask.  You may want to just remove the mask, itself, and breathe


 straight from the plastic valve mechanism.


Demand Valve:  You may have also heard of a “Demand Valve” system.  This is a totally different system, that is QUITE expensive to get.  It costs anywhere from $300.00 to $800.00 (USD).  Although it is up there in price, to those of us that use them (myself included), we swear by them.   They are the Rolls Royce of O2 systems.  To me, they are worth every penny they cost.  I do not recommend that you buy one of these to start with.  Get the less expensive, and easier to find non-rebreathing mask set up, to see how it will fit in your lifestyle, and if it is going to work for you.

Demand valve mask, hose, and regulator

Demand valve and mask


Bubbler/moisturizer:  This is a plastic bottle (usually) that is installed at the output of your regulator, that you attach the hose going to your mask.  You fill it with an inch or two of water.  This adds a moisture vapor to the oxygen that you breathe in.  Many people complain that their mouth and or nostrils get dry, while sucking oxygen.   The bubbler prevents that from happening.



Mouth Piece:
 Some cannot get a good seal around the mask, or just do not like having the mask on their face.  They use the mouth piece, and just breathe in through their mouth.  The setup shown in this picture has an extension, and then the mouth piece at the end of it.  It works great.  Before I switched to the demand valve system, the mouth piece was my preferred method of sucking on oxygen.
Oxygen concentrator:  It is also called a "machine" or "Oxygen generator"  ... Whatever it is called; it does not work for most of us.

The concentrator takes normal room air, and then purifies it so that it is mostly oxygen that it generates.  You do not have to refill any tanks, or any of those "hassles" ...  Sounds great, huh?  It would be if it worked.  

The key words to what I described are "mostly oxygen".  It starts out at producing about 75 to 80% oxygen, and then after it warms up, it could get as high as 95% oxygen.  Most machines can only produce about 7 LPM of "mostly oxygen".

There are two important reasons that the concentrator is not for us.  We need 100% oxygen and we need it at a minimum of 15 LPM.

Now, I WILL admit, there are a few, who can sometimes get results from this, but not fast enough, and nowhere near as regularly as with the bottled oxygen.  If your doctor or supplier tries to tell you it is just as good, don't believe them.  Get the bottled oxygen.

Typical oxygen concentrator

I have been asked where to buy the equipment needed for the oxygen therapy.  There are many places to find them.  You can do a Google search and find anything that you want.  Or, you can go on eBay, and hope for the best.  Be careful, when buying off eBay that you know what you are bidding on/buying.  I was looking at a regulator, on eBay, that I was not familiar with, so I did a Google search, and found out that the regulator on sale, was one that had been recalled by the manufacturer, due to the possibility of exploding, and causing a fire.  This is one of the chances that you take.

I have bought from eBay, and from sites I have found due to an internet search.  I have had good and bad results from each.  The most important thing is to know the equipment that you are buying.  Know the manufacturer, or at least the vendor.  Know the model you are interested in.  It may require a lot of Google searching, but you can find out this information.

NOTE: CH.com now has oxygen therapy equipment available directly through the CH.com store.  Click Here to order your ClusterO2 Kit!

First, you have heard us talk about using a non-rebreather mask.  The ClusterO2 Kit that you can purchase from clusterheadaches.com is the best on the market.  
Some people do not like having the mask over their face, so they use the mouthpiece.

If you notice in the picture to the right, there are arrows on the little yellow strips around the “T” valve assembly.  It is important that you assemble the equipment the way it is shown in that picture, whether you use the mask or the mouthpiece, the arrows MUST be pointed in the direction they are shown.

You have heard us talk about getting a regulator that goes to AT LEAST 15 LPM, but higher is better.  LifeGas is presently offering two regulators that go up to 25 LPM.  They may offer more, in the future, once they pass the rigorous testing and approval processes.

CGA870 connector that you would use on an “E” or “D” tank

CGA540 connector for the larger “M”, “H”, or “T” tanks

If you notice on the pictures above, both regulators have the nipple for your ClusterO2 Kit or non-rebreather mask hose to connect to.  They also have two DISS fittings, so that if now, or in the future want to step up to the Demand Valve System, they would connect there.  Only one is needed, but they offer two, and that is good.  With the two fittings available, you and your buddy could each hook up, with your own masks, at the same time.  Another advantage to them, is if one of them gets banged up and the threads destroyed, you can switch over and use the other DISS fitting, instead.


Now, talking about the Demand Valve System, here are some options that are available to you.  Remember, the Demand Valve System is considerably more expensive than the ClusterO2 Kit or plain non-rebreather mask, but for many of us it is well worth the cost.  If you are just starting out on oxygen therapy, I would not recommend that you go the expense of the Demand Valve System, first off.  Try the ClusterO2 Kit.  That may be all you need.  If the oxygen treatment is working for you, but you would like a faster abort time, then you might think about the Demand Valve System.

Demand Valve, hose and mask

Here is the system hooked up to the DISS
fitting on an “E” (or “D”) tank

This shows the option of replacing the mask
with just the mouthpiece, that some prefer
Or, you may wish to go with the mouthpiece, with the “T” valve fitting.

The advantage of the “T” valve fitting is that you can inhale and exhale through the mouthpiece.  If you just put the mouthpiece directly to the Demand Valve, you have to exhale through your nose, or the side of your mouth, or take the unit out of your mouth to exhale.  It is all in personal preference.


Demand Valve with "T" fitting

Another option that you can get is the 25’
extension hose, for the Demand Valve
System, if you are a pacer, like I am

I hope the above gives you a better understanding of what is available, and what options you might want to use.  

Tips and Information

BTW, I am NOT a doctor, nor a respiratory therapist.  I am just a clusterhead who has listened, read, and tried various methods, and found some that work, for me.

If you don’t have a non-rebreathing mask
The nose canula CAN work, if used this way: Do not put it in your nose. Put it in your mouth, close your lips around it, and inhale.  Open your mouth to exhale, and then close your lips, again, around it to inhale.  Breathe only through your mouth.  Do not inhale any “room air” only the

If you can’t get a moisturizer
Make your own.  Take an empty (and cleaned) mayonnaise jar (or something like that), drill two small holes in the lid, the size of the
O2 air line.  Cut your hose, a foot or so from where it hooks to the tank. Stick the hose from the tank into the lid, and far enough down so that it touches the bottom of the jar.  Take the hose that goes to the mask, and stick it into the other hole, but just far enough to stick through the lid.  Seal around both hoses with a silicon type sealant.  Put an inch or two of water into the jar.  No more than ¼ full!  I attached mine to the tank with a bungee cord.  BTW, if you put ice cubes into the water, it will cool the O2 somewhat.  Many feel this helps it to work.

To buy your own bubbler, follow this link.  (Thank you, Mr Happy)

If you are using a non-rebreathing mask
I hold the mask to my face with my right hand.  I hold it firmly to my face with the palm of my hand.  When I inhale, my index finger goes over and covers the holes on the left side of the mask (the ones with the rubber valve over them), this is to make sure the valve seals fully.  I place my thumb over the holes on the right side of the mask (the ones without the valve on them).  I use my right hand, so that my thumb covers the holes on the right side.  My thumb is larger than my fingers, so it does cover the holes completely.  When I exhale, I just lift the finger and thumb (keeping the mask to my face by the palm of my hand), and let the air out of those holes.  Some people tape over them.  It works better for me, the way I describe it, as you don’t have to lift the mask, when you exhale.

When and how long to use the O2
Grab the
O2 as SOON as you feel it coming on.  Speed is the name of the game.  The sooner you get on the O2, the better the success rate.  Stay on it for 15 to 20 minutes.  If it has not killed the hit, stop using it. Bear through 10 minutes without the O2, and then hit it again.  If the O2 does not work the first time, the second time is almost always the charm for me.  Something about that 10 minute break seems to do it, for me.
You don’t need to stay on it for the full 20 minutes, if it stops the hit well before that time.  BUT, stay on it for 5 minutes AFTER the last of the pain is gone.  The first and last place I have pain is just above my cheek bone, at my temple.  I press my finger into that spot, and if I still feel some pain, I stay on the
Trial and error will let you know what works best for you.

If O2 does not or stopped working for you
Try it again.  I have gone through periods where it did not work at all.  There have been other periods, where it only worked about 20% of the time.  Keep trying it.  Even if it only works a few of the times, those are hits that you did not have to take Imitrex or suffer though a full hit.  It has far fewer side effects than any other medication.  It is worth it to keep trying.

Acquiring oxygen in an emergency
If you run your tanks dry and can't get your supplier to fill them, try going to your local Fire Station.  There are EMT's (Emergency Medical Technicians) who are trained in giving oxygen.  They are often willing to help you more than if you went to the Emergency Room and had to deal with staff that may be ignorant of oxygen therapy for cluster headache.

Medical reference
(16th Edition) of Harrison's Principles of Internal Medicine.   It's IN THE BOOK as a valid treatment/therapeutic (don't remember the exact wording here) use for cluster headaches.
- Peppermint  

Keep an oxygen supply
Don't run out of oxygen!  Always know how long your oxygen supply will last and how long it will take to get a resupply.  At 12 LPM an "E" tank will only last 44 minutes. An "H" tank will last 8.3 hours. Here is a calculator to determine how long your oxygen supply will last: http://www.monroecc.edu/depts/pstc/backup/paraoxca.htm - Biker bob

If your doctor will not prescribe a high flow regulator
Buy your own regulators on EBay.  Think long term.........once you have the O2, make sure you have the right accessories for proper delivery. Don't count on anybody else to provide the Right Stuff. You're gonna be at this for a while - Mr Happy


High Oxygen Flow Rates for Cluster Headache

(Editor’s note: In the following article, Dr. Rozen talks about flow rates of 7 to 10 and up to 15 LPM.  Newer studies and trials are showing that flow rates up to 25 LPM, may be more beneficial.)

From the newsletter Headliner, 2004, Issue 33, published by the Michigan Head-Pain & Neurological Institute.  Reprinted with permission.

 "High Oxygen Flow Rates for Cluster Headache"
                by Todd D. Rozen, M.D., Neurologist

As discussed in previous issues of the Headliner, 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 for 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. The author 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.

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 the 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 and 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.

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 are needed to provide conclusive evidence regarding the usefulness of high oxygen flow rates for difficult-to-treat cluster headache patients.

Headliner is published and privately distributed by the Michigan Head-Pain & Neurological Institute for informational use by our patients and friends. Rights to reproduction belong exclusively to Michigan Head-Pain & Neurological Institute. For additional copies or further information contact:

Jeffrey Pingel, Ph.D., or Scott Madden, Editors, Headliner
Michigan Head-Pain & Neurological Institute
3120 Professional Drive, Ann Arbor, MI 48104


Getting the Prescription

Next is a way to help your doctor to agree to prescribe oxygen.  It has helped a few clusterheads to get their doctor to agree.  Print out the information and drop it by the doctor’s office several days before your visit.  DO NOT expect your doctor to sit down and read information that you bring with you, to your visit.  He/she just does NOT have the time, right then, to do so.  Give him/her a break, and let the doctor prepare BEFORE you show up.

Also, explain to the doctor that you don’t need the oxygen to just increase your blood/oxygen concentration.  What you need, and what you are looking for, is the vassal constricting qualities of oxygen.  It is believed that what causes our pain is the vassal dilation, that pushes against, or aggravates the hypothalamus, which then triggers the pain.  When sucking oxygen up to at LEAST 10 to 15 LPM, the vassal structures then compress, or constrict, which relieves the pressure on the hypothalamus.  PAIN GONE!

I say “at LEAST” 10 to 15 LPM, because there is a certain school of thought, of which I adhere to, that believes that an even higher flow rate works faster and more efficiently.  My regulators go up to 25 LPM, or I can connect my demand valve to it.  I won’t go into detail about these niceties, here.  This thread is to help you get set up, and succeeding with oxygen therapy.

Proper Wording for Prescription

Oxygen @ flow rate of 12-15 liters/minute with a non-rebreather mask, as required.

The important thing is to get your doctor to prescribe the oxygen.  Maybe your doctor will only prescribe you with oxygen at a flow rate of 5 or so LPM, with a nose canula.  That is fine!  The important thing is to get the prescription for the oxygen.  We can help you get the other items needed.  You do NOT need a prescription to buy a different regulator, and a non-rebreathing mask.  

I hope this helps you to get the all important prescription for oxygen.  The argument about using the “vassal constriction” argument seems to have done wonders for a few clusterheads that I have suggested this to.  The doctors seem to be, first, impressed that you even KNOW about that capability of oxygen, and second, can also see the logic to the argument!

Remember, if you have more questions, come in here and ask.  That is one of the main reasons for this site!  Ask away!  We want you to get PF as quickly as possible.  There are many of us that swear by the oxygen regime.  Collectively, we have THOUSANDS of hours of successful use of oxygen therapy.  We want YOU to get the benefits, also!

BE PATIENT!  I believe the reason some people don’t get the best results from O2 is that they don’t stay on it long enough.  I am of the school of thought that oxygen will work for 99.9% of sufferers.  Those that say it does not work for them, are doing one (or more) of the following things wrong:

  • Wrong method or usages

  • Wrong delivery method

  • Wrong flow rate

  • Not getting on it soon enough

  • Improper or defective equipment

Even if oxygen did not work for you in the past, try it again.  Chat, call or post exactly how you are using it, and one of us should be able to help you get better results.

OXYGEN has made a HUGE, positive impact, on my life, and most especially, the QUALITY of my life!

Comments from Users:

"My preferred method is to count the number of breaths I take to get rid of the hit & then stay on the O2 for the same amount of breaths, I can usually abort a hit with about 80 to 100 breaths but I breathe straight from the bag as I have a beard & can’t get a proper seal with the mask.

The most important thing is to be absolutely sure that you have killed the hit, no "maybe’s" or "nearly", if you don’t ensure its gone before you do the follow up breathing there’s a good chance of getting a rebound hit & that will be even harder to get rid of than the original one."

- Barry


"O2 works, and works well for most people, but you need to hit it as soon as you feel it start to come on. It kills the hits faster, the sooner you can start breathing it."

- purpleydog


"...since I can't stand to have anything touch my face during and an attack during my last cycle, I stuck the tube directly in my mouth, cranked up the O2 to 25 LPM, and hyperventilated.  Thanks to thebbz, I found a mouth piece that I can use.  I haven't found an abortive  that works as good as that.  I burn up a half of a bottle that way but man does it work.  If I can catch it within the first 15 to 45 seconds it usually doesn't get above a 5 or a 6 and the attack lasts less than 5 minutes."

- Johnny


"I've been doing more research and collecting additional data on abort times as they relate to oxygen flow rates, non-rebreather (NRB) masks, and carbon dioxide (CO2) buildup and how these factors impact the effectiveness of oxygen therapy to abort cluster headache attacks.  The buzzword is hyperventilation.

In keeping with the standard disclaimer, I’ve provided the following for information purposes only.  See your doctor or neurologist for medical advice and treatment of your cluster headaches.  They’ll catch up with us at some point.
An oxygen flow rate of 12-15 liters/minute with a non-rebreather mask is a MUST on your prescription for oxygen therapy, as is the phrase, "AS NEEDED FOR CLUSTER HEADACHES."

In practice, 15 liters/minute is the minimum effective oxygen flow rate used by most successful oxygen therapy users – the really successful oxygen therapy users have oxygen regulators capable of delivering 25 liters/minute or higher.  Any flow rate less than 15 liters/minute, for example at 7 to 9 liters/minute, can easily result in a build up of CO2 due to the increased physical activity associated with the cluster headache attack AND the restricted respiration rate caused by the non-rebreather mask.  All this results in a situation where you cannot achieve an abort with oxygen therapy when the respiration rate is constrained by using low oxygen flow rates administered with a non-rebreather mask.

Although an oxygen flow rate of 7 to 9 liters/minute will easily result in a hemoglobin oxygen saturation at or near 100% under normal conditions, a respiration rate constrained to this flow rate by using a non-rebreather mask will result in a CO2 build up well above normal and displace or not leave room for oxygen molecules to attach to the hemoglobin in each red blood cell.  In short, while you may be getting more oxygen than normal at a flow rate of 7 to 9 liters/minute, the restricted respiration rate allows CO2 in the arterial blood steam to climb above normal levels.

It gets worse…  It's not the lack of oxygen that controls the rate of respiration, it's the level of CO2. During strenuous activity, CO2 builds up faster in the bloodstream than it can be expelled from the lungs at normal respiration rates.  As a result, chemical receptors in the body signal an increase in respiration to reduce CO2 levels, and you start gasping for breath panting like a big dog.  

On top of that, CO2 is a powerful vasodilator.  As a cluster headache attack is associated with a dilation of the arteries and vascular structures around your trigeminal nerve, a buildup of CO2 above normal levels causes increased vascular dilation and that makes cluster headache attacks more painful and last longer.  

CO2 is such a powerful a vasodilator that even a slight increase in CO2 above normal levels will totally negate and overpower the vasoconstriction (a cluster headache abortive mechanism) provided by breathing 100% oxygen.  As CO2 levels continue to build, you start having panic attacks and become even more animated generating more CO2. It's a vicious cycle.

The only way to prevent CO2 buildup during oxygen therapy is breathe at a rate faster than normal and with a greater tidal volume than normal.  This is called hyperventilation and requires a minimum oxygen flow rate of 25 liters/minute.  

Preventing CO2 buildup may not be possible at high Kip-levels even with an oxygen flow rate of 15 liters/minute and a properly functioning non-rebreather mask.  A higher respiration rate (and oxygen flow rate) will be needed when cluster headache attacks rise above Kip-6 to Kip-7 on the pain scale.

The normal adult respiration rate at rest is 15 to 18 respiration cycles/minute with an average of a half liter tidal volume.  Tidal volume is the volume of air inhaled and exhaled with each breath.  If you do the math, a flow rate of 7 to 9 liters/minute and a tidal volume of .5 liters, works out to a respiration rate of 14 to 18 cycles/minute.  At an oxygen flow rate of 15 liters/minute and a tidal volume of 1 liter, the respiration rate is 15 cycles/minute.  Again, even that respiration rate will be insufficient to cast off excess CO2 during a high Kip-level attack while you’re dancing around the room doing the tarantella (or Cha-Cha) and banging your head off the wall.

I’m an old Navy fighter pilot with over 3000 hours flying Navy jets.  All of that flight time was spent breathing 100% oxygen continuously from takeoff to touch down on missions lasting over 2 hours and on some extended mission lasting up to 7 hours.  I can also guarantee you that I would routinely suck down that 100% oxygen at flow rates well above 30 liters/minute at high respiration rates.  

I’m still here… so the safety of breathing that much 100% oxygen for periods of 2 hours or more is not an issue.  In fact, the US Navy has been requiring Navy and Marine Corps pilots flying tactical fixed-wing aircraft to breathe 100% oxygen from takeoff to touch down for over 60 years.
I’ve also been using oxygen therapy since I went chronic over 4 years ago and for the last two, at flow rates well above 15 liters/minute.  I’ve not used any other cluster headache medication except oxygen in the last 2 years and now routinely abort my attacks in two to three minutes.

The message of this post is equally simple.  Hyperventilation with 100% oxygen is the key to successfully aborting cluster headache attacks.  Oxygen is good and CO2 is bad."




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