I can not hyperventilate o2 unless I am at 40 lpm. 

Sometimes I use 25 lpm in middle of the night when I am too tired to hyperventilate, but takes longer as compared to 40 lpm hyperventilating.

I'm not 100% effective at complete abort with o2, but certainly helps reduce pain level to KIP 1/2.

Does anybody have suggestions of how to effectively abort using o2?

i.e. inhale nose, exhale mouth?
inhale/exhale nose only?
inhale/exhale mouth only?
sitting, standing, laying down?
fast inhale, fast exhale?

Any suggestions?

I'm halfway thru an M tank in less than 5 days getting hit every 3 to 4 hours, at "peak" f cycle and hopefully ending NOW! :(

LasVegas wrote on Oct 9^th, 2011 at 1:32pm:

I can not hyperventilate o2 unless I am at 40 lpm.  Sometimes I use 25 lpm in middle of the night when I am too tired to hyperventilate, but takes longer as compared to 40 lpm hyperventilating. I'm not 100% effective at complete abort with o2, but certainly helps reduce pain level to KIP 1/2. Does anybody have suggestions of how to effectively abort using o2? i.e. inhale nose, exhale mouth? inhale/exhale nose only? inhale/exhale mouth only? sitting, standing, laying down? fast inhale, fast exhale? Any suggestions? I'm halfway thru an M tank in less than 5 days getting hit every 3 to 4 hours, at "peak" f cycle and hopefully ending NOW! :(

Relax,  sit on a upside down five gallon bucket. The upside down part is important or you'll get a ring-around-the bottom.
  Breathe In and out and In and out and In and out and In and out.

         Potter

All I have are the orange Homer buckets from Home Depot will that suffice?  Sarcasm really not appreciated when sincerely seeking help! >:(

Anybody with serious advice on aborting attacks with high flow o2? :-[

I failed to see the sarcasm, LV. He was being funny. There's a difference.

Sitting on something that doesn't allow you to lean back forces you sit up straight, giving your lungs the proper position for maximum efficiency.

Lighten up, dude.

That makes sense Brew, thanks. 

Extremely impatient at peak cycle with no tolerance for anything but cut to the chase-bottom line, no offense Potter.

When limited to 25lpm I tend to full the lungs as full as possible and exhale until I can do no more. I try to match as closely as possible, the above method to the filling of the bag so I do not feel starved for air. It's not as effective as hyperventilating on my demand valve, but it does work and beats hell out of many other options.

Thanks Racer, I appreciate your reply

I think you need to experiment until you find what works for you, but you do raise a good question about how to inhale and exhale. Not too long ago we had various threads on using ice cold water as a means of moisturizing the O2. I didn't do that, but I did find that using the demand flow valve, or the 25lpm regulator, did after awhile make the O2 rather cold. And I began to wonder if that was also helpful. It seems so. I try to breathe in through both my mouth and nose at the same time, and the cold O2 seems more effective than the warmer O2 I get at first. It might just be me, though. And if I'm not in a desperate panic, I exhale with the mask off. If I am in panic, I breathe as rapidly as I can and the pain sets the pace until I'm in a better position to breathe more deeply and deliberately. The Monster drink also seems to help cut abort times. When I began using O2 I was amazed at how it mitigated the pain, and cut abort times to 15-20 minutes. Then, using a demand flow valve, I found abort times dropping to 3-5 minutes. Getting on the O2 as soon as I think the hit is coming seems also to be critical to abort times. Good luck and God bless. lance

1st I use a mouth piece instead of a mask.  Facial hair ya know.  Tough to get a good seal.  So I'm always breathing in and out of my mouth.

With my m-tank I use 40lpm and sit on the stairs or edge of the bed and rocks back and forth.  The guys up top are right, it keeps the rib cage open and allows you to get the lungs completely full.

If I'm out and using my e-tanks, the max rate is 25lpm.  That is tougher to use and takes longer.  Like Bill says, breath slow and deep.  Match your breathing rate to the rate of flow.  Tough to do in a panic but it works eventually. 

Lance is also right.  Cold O2 works better than warm O2.  I Keep my tanks in a cool place. 

Back it up with an energy dring and you should be good to go.

-Dennis-

Keep in mind, too, that the physical process of a compressed gas expanding is a natural cooling process. The O2 exiting a tank that was kept in the hot car will be cooler than the hot car was (by how much, I'm not sure, but it could be calculated).

Hey LV,

My favorite topic... Good question and you've received excellent suggestions to improve the effectiveness of the oxygen therapy in aborting your CH.  Let me summarize them and give you some of the rationale why I think they're important.

Potter was spot on.  Body position is a great starting point.  As the essential mechanics of this method of oxygen therapy involves ventilating the lungs as completely and efficiently as possible, body position is important.  I like to stand and lean against a wall, drop my jaw like saying the word "Haw" then use the breathing technique called hyperventilating with forced tidal volume breathing from my mouth as there's less restriction than through the nose... 

Other than a rapid abort, the goal of effective oxygen therapy with hyperventilation is two fold...  Inhale oxygen at the highest concentration possible, and exhale CO2 faster than your body generates it through normal metabolism...

I stand with shoulders back as that gives the diaphragm full range of motion and lean against a wall as you will get dizzy if you're using the breathing technique properly.  If you get too dizzy, sit erect in a chair, stool or over-turned bucket as Potter suggested.  Above all, try to avoid assuming the fetal position hunched over your knees...  That limits lung ventilation.

I also prefer breathing straight from the green "T" manifold on the O2PTIMASK™ or the 22 mm coupler on the demand valve.  This provides the least flow resistance and minimizes re-breathing the residual volume of exhaled breath in the "T" manifold that contains highest concentration of CO2...  This is important as CO2 stimulates vasodilation and slight elevation in arterial CO2 levels can occur even when breathing 100% oxygen at 15 liters/minute due to inadequate lung ventilation.  That will result in longer abort times as CO2 is a more powerful vasodilator than 100% oxygen is as a vasoconstrictor.

The most effective method of pumping CO2 from the lungs is hyperventilation and the best way to do this is by using the breathing technique that starts with exhaling at forced vital capacity tidal volumes. 

You do this by exhaling forcefully with jaw dropped until it feels like the lungs are empty...  They're not...  Without hesitating, do an abdominal crunch like in doing sit-ups and squeeze the chest chest muscles then hold the squeeze until your exhaled breath makes a wheezing sound for a couple seconds. This will squeeze out another half to a full liter of exhaled breath.  As this last volume of breath you exhale, the end tidal flow, contains the highest concentration of CO2, you'll be pumping CO2 from your lungs as effectively as possible.

After a couple seconds of wheezing, inhale rapidly without any delay until it feels like your lungs can't possibly hold any more then repeat the forced exhalation without delay.  Keep repeating this sequence as rapidly as possible until the abort.  As you're ventilating the lungs more than needed with this procedure and breathing technique...  you're hyperventilating.

Try this with room air.  If you're executing this procedure and breathing technique properly you should start feeling the symptoms of paresthesia after three to four complete breaths.

The symptoms of paresthesia are an important indicator that you're hyperventilating effectively.  They include a very slight tingling or prickling of the fingertips, lips, or back of the neck.  You'll also experience a slight dizziness or feel a little woozy.  As strange as this may sound these are good symptoms and the best indication you'll get the fastest abort possible.  Remember what they feel like.  If you don't experience them during oxygen therapy... you're not breathing correctly... and your abort will take longer.

This method of oxygen therapy is hard work.  You're forcing yourself to breathe at a faster rate and at a greater tidal volume of breath than your body's normal respiratory control mechanism is signaling.  If you're doing it properly, you will get tired. 

Accordingly, a high-flow oxygen regulator good for flow rates up to 40 liters/minute or a demand valve make this method of oxygen therapy possible.

Tips and Fine Tuning...  I've found that exhaling away from the green "T" manifold on the O2PTIMASK™ in stead of through it and out the exhaust flapper valve eliminates re-breathing the small volume of exhaled breath in the "T" manifold highest in CO2.  I press the open end of the "T" manifold lightly against my lower lip while exhaling to block any loss of oxygen while the reservoir bag fills.

Starting oxygen therapy early at the first sign of an approaching attack is best...  That includes shadows...  A shadow is just another cluster headache.  If the CH wakes you from sleep, get on the oxygen ASAP!...  You're already behind the problem and any delay will only add more time to the abort.

Data we collected during a study of this method of oxygen therapy we conducted 2007-2008 revealed a simple fact many of you already know...  After analyzing the results of 366 aborts with this method of oxygen therapy, we found the higher the CH pain level, the longer the abort times.

We also found the relationship between abort times and CH pain levels was linear up to pain level 6 on the 10-Point headache pain scale.  In other words a KIP-3 took an average of 3 minutes to abort, a KIP-4, 4 minutes and so on up to KIP-6. 

At pain levels above KIP 6, the relationship between pain levels and abort times becomes exponential.  For example, a KIP-7 took an average of 8 minutes to abort, a KIP-8 took 9.5 minutes, and a KIP-9 took an average of 12 minutes.

Keeping the oxygen cylinders stored in a cool location helps as well.  This is also an area where the demand valve has an advantage...  The rapid expansion of compressed oxygen as it expands from 120 psi (8 BAR) to ambient that takes place within a demand valve cools the oxygen flow considerably.  I've measured the temperature of the oxygen cylinder and then the temperature of the oxygen coming from the demand valve with the purge button pressed and came up with the following.  The purge valve is rated at 40 liters/minute...  The temperature of the oxygen cylinder was 70º F and the temperature of the oxygen coming from the demand valve was 42º F. 

I also measured the temperature of the oxygen coming from my O2PTIMASK™ at a flow rate of 40 liters/minute selected on the Flotec InGage™ oxygen regulator and it was 65º F.  This resulting temperature is due to the regulator on the oxygen cylinder absorbing some of the chill from the expanding oxygen and thermal gain as the oxygen travels through the oxygen tubing.  Clearly the shorter the tubing down to 3 meters, the better.

Another tip I've found helpful I call acu-ice.  An ice bag on top of the head during oxygen therapy was always too painful as I used to have cutaneous allodynia and the large area of the ice bag only made it more painful.

Instead of the ice bag, I would take a single ice cube and wrap in in a wet paper towel then place it on top of the head just off center on the hit side on a line even with the front of the ear. 
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGESTART PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE
As the graphic illustrates, this location corresponds to an area between a branch of the greater occipital nerve and the supratrochlear nerve that run under the scalp in this area.  The exact location is usually easy to find as it will be more painful when you press on it with a finger.

Placing the paper towel wrapped ice cube between the ends of these two nerves created a numbing effect that helped lower the pain of my CH.  It stings like heck for three to four minutes, but when the sting subsides, the numbing effect takes over and starts providing relief.

I got fancy after a while and sealed the paper towel wrapped ice cube in a small food saver plastic bag and kept a couple of them in the freezer so they were ready to go when the next hit arrived.

Hope this helps.

Take care,

V/R, Batch

This is all really great wisdom from each of you, thank you all sincerely.   ;)

I too found it difficult at first and almost gave up on Oxygen, Batch's informative posts and help from some of the folks here made me a believer.

I do think you have to try several methods, mouthpiece, facemask, posture etc. to find what works best for you.

Good luck and do keep us posted.

Baer

Glad i'm not the only one impatient, thanks for sharing Baer.

Question that probably all of you will know who use o2 to abort attacks...

...Have you noticed PF time btw attacks are minimal w/ o2 use as compared to Imitrex injections or nasal sprays?

I've found Imitrex gives me at least 5 hours of PF time after I inject or use the spray, whereas I often leave the o2 with a KIP 1-2 (tolerable) and then find myself getting hit again anywhere btw 30 minutes and 3 hours maximum.

Perhaps it is the fact I have not been using it properly, perhaps there is some truth to minimal PF time btw attacks using o2 as compared to trex.

I realize we all want to avoid meds if something natural such as o2 is available, just sharing my personal observation and seeking input from those experienced.

Thoughts?

I have the same problem, I would re attack within 10-20 minutes of shutting off the 02. For many years, I was popping an oral cafergot when I started the oxygen. The 02 would abort the attack, the cafergot would buy me up to 12 hours pain free time. Cafergot is an old school CH med.

A couple cycles ago, at the suggestion of some on the board, I replaced the cafergot with a sugar free red bull. When my wifey hears me fire off the oxygen tank, she pours me one "on the rocks!" I take swallows of the red bull between breaths on the oxygen. It seems to speed the abort, and pushes off the re attack by several hours.

Might be worth a shot. Still hoping the pred burst kills the cycle for you, hang in there, high cycle sucks.

Joe

LV,

What you're experiencing with the increase in frequency of your CH after starting this method of oxygen therapy is normal... 

Most CH'ers experience an increase in the frequency of their CH after starting oxygen therapy for the first time or at the start of each episode/cycle.  The good news is the CH frequency also starts dropping around the fourth week of using this method of oxygen therapy all on its own. 

We think the drop in frequency of CH attacks is due to vascular toning.  In other words, repeated sessions of oxygen therapy with hyperventilation that trigger vascular constriction of the arteries gradually tone up the muscles lining the arteries just like doing repeated dumb bell curls tones up the biceps. 

Once these arteries are toned up, they become more resistant to the cluster headache mechanism that triggers them to dilate.  That's our thinking at this point.

The chart below from our study of oxygen therapy at flow rates that support hyperventilation illustrates the phenomenon of increased CH frequency up to the fourth week followed by a marked decrease in CH frequency.  We observed this same pattern in all study participants.

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGESTART PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE

You'll also notice that the average CH pain level and average time to abort dropped continuously from start of therapy over the 8 week period of the study.

After analyzing the data, we came up with a term for this phenomenon...  If the interval between a successful abort with this method of oxygen therapy is greater than 15 minutes and less than 40 minutes, we call this a re-attack CH as opposed to a rebound CH. 

We arrived at this distinction because a rebound headache is defined as being caused by a growing resistance to the headache medication due to overuse.  If we were resistant to oxygen, we'd be on the wrong side of the air-earth barrier pushing up grass.

What we think is happening is the aborts with this method of oxygen therapy are so fast, they abort the pain of the CH but not the underlying triggering mechanism.  When the effects of respiratory alkalosis dissipate (this takes between 15 to 30 minutes), and the triggering mechanism is still active, the CH returns.

If the interval between a successful abort is 45 minutes or longer, the CH is likely a "normally scheduled" attack.  In either case, these CH should all abort rapidly with this method of oxygen therapy.

If the CH returns in less than 15 minutes after an apparent abort, the abort of the pain was likely incomplete.

We discovered this phenomenon during our study and to test it, we asked participants to stay on oxygen after the abort.  After several attempts to determine how long to stay on oxygen after the abort, we found that if you stay on 100% oxygen after a successful abort to a pain free condition long enough to bring the total oxygen time up to 15 minutes, the incidence of re-attacks dropped significantly.  When the total oxygen time was 20 minutes, we found the incidence of re-attacks dropped to zero. 

For example, if it takes 8 minutes to achieve a successful abort to a pain free state, keep breathing 100% oxygen for another 7 minutes, but at a normal respiration rate and tidal volume of breath...  i.e., breathe normally.

Hope this helps.

Take care,

V/R, Batch

Wow, yes Batch, that helped tremendously, thanks for sharing...now go write a book  ;)

Yep, I agree...go write. I would get a few copies. Lay 'em out and round hoping that "someone" might pick one up and take a look inside! :)

There's a reason we call him  our "Oxygen Guru!" [smiley=bow.gif] [smiley=bow.gif]

Joe

Beth E wrote on Oct 13^th, 2011 at 6:58pm:

Yep, I agree...go write. I would get a few copies. Lay 'em out and round hoping that "someone" might pick one up and take a look inside! :)

Try the reverse psychology approach. Let him see you reading them, but always clear them away. He won't be able to help himself in wanting to read them!

This method works great with cats.

All I can say is absorb everything Batch says.  He has been my savior through the years. I've been in remission for roughly 1.5 years and when the beast comes back, I have no worries because Batches techniques using O2 gives me my life back while in cycle.  Otherwise, I bust and exercise to keep the beast at bay.  All the best!

Chad

Thank all of you for the kind words...  Now I need to go down in the basement, pry open my cruise box, dust off my flight helmet that I haven't worn for over 30 years, and strap it on real tight to prevent my head from swelling...

All kidding aside, the E-Book - A Fighter Pilot's Experience With Cluster Headaches and How to Treat Them with Oxygen Therapy at Flow Rates That Support Hyperventilation... (not its real title) with photos and video links illustrating how to use it properly was almost complete...  until the unexpected happened...  and I stumbled onto the anti-inflammatory regimen...

The anti-inflammatory regimen has taken off and it's gaining speed as a very promising cluster headache preventative...  Not only have I gone pain free on this regimen, and remained that way for over a year, but so have many other CH'ers here at CH.com and even ClusterBusters...  I have CH'ers contacting me from all over the world sharing their experience with this regimen...  Talk about a head trip...  and none of this would have been possible without this site and support from all of you.

The potential for this regimen to become a game changer in the standards of care in treating cluster headaches is becoming so real, it deserves the same disciplined approach we gave to oxygen therapy at flow rates that support hyperventilation. 

In short, we need to gather the medical evidence to substantiate proof of its effectiveness.  This includes a treatment protocol with lab tests, optimum dosing, possible comorbidities and what to expect. 

If you follow where I'm going... you'll recognize a clinical study is the only way to gather the required medical evidence with respect to proof of safety and effectiveness needed to keep the Nay-Sayers away and attract the attention of key neurologists and headache specialists experienced in treating patients with cluster headache.  All that takes time and funding... 

At this point... the ball is already rolling...  Once we have the evidence in hand, the E-Book will go on line so you can download or send the link to other CH'ers in need.

In the mean time, you'll continue to see my posts on this topic encouraging CH'ers to see their doctors and neurologists and to ask for the 25-Hydroxyvitamin D, a.k.a. 25(OH)D lab test for this serum level metabolite of vitamin D3...  and when this lab test comes back deficient at ≤100 nmol/L, (40 ng/mL)... to start the anti-inflammatory regimen with vitamin D3 therapy.

All for now...  and thank you again for the kind words... I'll keep you posted.

Take care,

V/R, Batch

Since my attacks are longer than most, I have seen the re-attack phenomenon well. The rush I get before each attack feels like a chemical releasing in my body... then smack! As long as that mechanism is active, I can only blow a hole in the pain with O2...till the mechanism starts to sputter, then I end it completely. I was gonna say stay on the O2 a little longer to open up that PF window.