Post by Batch on Aug 29th, 2008 at 2:09pm
n_lighty37 wrote on Aug 28th, 2008 at 12:06pm:
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Interesting Rx… I wonder how well your doctor actually understands cluster headaches? Did she ask you if your eye on the hit side starts watering around Kip-6 to Kip7? And, did she ask you if your nose started running and became congested at that pain level as well? I don’t know about you, but when my attacks reach Kip-6 – Kip-7, both happen to me and that makes inhaling through my nose difficult to impossible as the pain level rises.
Having said that, I need to be careful not to dismiss a new method of administering oxygen therapy out of hand. Your doctor may be on to something I’ll go into a bit later, but I wonder where she thinks the oxygen goes after it’s inhaled through the nasal passages? Two years ago I became painfully aware that the 7 to 9 liters/minute flow rate suggested in the standards of care/treatment for cluster headaches and initially prescribed by my doctor was insufficient. I found that 15 liters/minute worked better and that even higher flow rates were even more effective in aborting my attacks. I started discussing these higher oxygen flow rates over a year ago here on the boards and in a Supplemental User’s Guide for Oxygen Therapy several of us developed and posted on the OUCH web site about that time…
I now use much higher flow rates, and wouldn’t start oxygen therapy at anything less than 25 liters/minute. Having researched this topic extensively over the last two years, I’ve posted the rational for using these higher flow rates several times as being very safe, very effective, and far less invasive than all the other preventative and abortive medications that carry some onerous side effects. One of the latest of these posts is on the Medications, Treatments, Therapies forum, in Chuck’s post titled ‘Help in getting OXYGEN prescribed’ - Reply #6. The short answer from that post is when it comes to using oxygen therapy as an abortive, oxygen is your friend and CO2 is your enemy – Use an oxygen flow rate that supports hyperventilation.
Now for the bit about passing oxygen through the nose and nasal passages… This will get a bit long winded so please bear with me… The surface area of the nasal passages is much larger than most would suspect, but it’s nowhere near the surface area of the lungs that are estimated at a surface area of some 160 m2. That’s almost equal to the area of a singles tennis court and 80 times the area of our skin! Accordingly, the amount of oxygen absorbed into the bloodstream through the nasal passages would be insignificant when compared to the amount of oxygen absorbed by our lungs, but there is another factor to consider.
We’ve all found that cold ice packs on the head, neck, and face, chewing ice, and drinking cold fluids appears to help in the process of aborting our attacks. The basic principle behind this is cold stimulates vasoconstriction. I took that one step further in the User’s Guide where I suggested in one of the tips about a technique of using the mouthpiece attachment on the oxygen mask manifold shown below on the left and allowing the oxygen to free-cycle through the mouth, up into the back of the nasal passage and out the side of the nose on the hit side.
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
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END PRINTPAGEThe thought here was that the very dry oxygen would cool the nasal passages, not from the temperature of the oxygen, but rather through the process of evaporative cooling. As the sphenopalatine ganglion is located at the back of the nasal passage and it’s much closer in proximity and actually linked neurologically to the trigeminal nerve, it stands to reason that cooling that area could be beneficial in aiding the abort process by stimulating vasoconstriction in and around the trigeminal nerve.
There’s another cluster headache abortive therapy used by some neurologists that lends further credence to this notion. That therapy involves intranasal administration of a topical 4% lidocaine solution to anesthetize the sphenopalatine ganglion that’s located at the back of the nasal cavity. There are also several studies suggesting that the sphenopalatine ganglion participates in the mechanisms of cluster headache pain. These findings indicate the local administration of an anesthetic agent such as a lidocaine, as a sphenopalatine ganglion block, is effective in aborting cluster headache attacks.
Although any comments on the efficacy of free-cycling oxygen through the mouth and out the nose would be anecdotal at best, I’ve found using this technique has a soothing effect when used for 20 to 30 seconds as a break from breathing 100% oxygen at the higher respiration rates that support hyperventilation. It takes a few second to master this technique, but once you relax the back of your throat and exhale gently through the nose, you’ll feel the flow start.
I also allow the reservoir bag to fill completely so there is sufficient pressure to allow the oxygen to work its way through congested nasal passages. If the nasal passage on the hit side is too congested, I gently press on the opposite side of the nose to block the flow from that side in order to insure the evaporative cooling is directed to the hit side. The longer you let the oxygen free-cycle, the colder that area of the nasal passages get. Although higher oxygen flow rates accelerate the evaporative cooling effect, I found this technique is just as effective if I adjust the flow rate down to 15 liters/minute during these short free-cycle sessions. It works for me.
Take care,
V/R, Batch