Fellow CHers,
First, because of this site and our "sister" clusterbusters site, I've been generally CH free over the past couple of years. After suffering from CHs for 17 years, I finally have somewhat of an approach to managing my cycles and in some cases, eliminating episodic cycles all together (I'm had both chronic and episodic, but haven't had an episodic cycle for 5 years). I'm grateful for the help that both groups provide as I now acquire oxygen myself and self-treat with alternative methods that have been as good as winning the lottery!

I recently started a short cycle (or I hope that's what it is) because of circumstances that prevented me from my usual approach to preventing cycles. I always have my O2 ready and have been using it to abort attacks, usually within a short period of the CH beginning. What I've noticed, or so it appears, is that I either have "rebound" headaches. This hasn't happened to me in the past. During cycles I typically will get 3-4 CHs per day, with one being a Kip 10+ if I'm unable to abort it. For the past couple of days I've been aborting with O2 and then having rapid succession CHs within the following hours. For example, the last two days I've had 3-4 CHs per night, within about an hour of each other, after aborting each with O2. I had tried sumtriptan in the past but that clearly caused rebound headaches, only worked about 30% of the time, and I hate medications anyways!

Here's my question: Is there any evidence to support oxygen therapy as causing rebound headaches? Has anyone experienced this? I read some scientific literature that mentioned O2 rebound headaches but it didn't seem there was enough data to support the claim. Just to be clear, I would much rather deal with short rebound CHs then a full blown Kip 10. I'm just interested to see if anyone has experienced this and if there is a potential way to prevent them (stay on O2 longer after the CH aborts?).

Cephalalgia. 2011 Jun 23. [Epub ahead of print]
Rebound following oxygen therapy in cluster headache.
Geerlings RP, Haane DY, Koehler PJ.
SourceAtrium Medical Centre, The Netherlands.

Abstract
Background: Rapid recurrence of a new cluster headache attack following oxygen treatment was named the 'rebound effect' by Kudrow (1981). It has never been studied properly. To study this effect, we defined it as a more rapid than usual (for the individual patient) recurrent cluster headache attack after complete relief following oxygen therapy, or an increase in the number of attacks per 24 hours while using oxygen therapy as acute attack treatment. We reviewed the literature and searched our cluster headache study databases. Case series: In our eight patients with rebound cluster headache, the effect was experienced following 87.5% of oxygen treated attacks. Duration until the next cluster headache attack was on average 894 minutes shorter and frequency was on average 1.6 cluster headache attacks per day higher than without oxygen therapy. Conclusion: Although the 1981 trial reported a prevalence of 25%, rebound cluster headache following oxygen therapy is rarely reported nowadays. This may be due to better techniques in oxygen application, the use of higher oxygen flow rates or underreporting. The few literature data and data on our eight patients did not provide clues about the mechanism of the rebound effect. Further study, applying the proposed definition, seems useful.

PMID:21700644[PubMed]

Hey ClosetCHer,

Good questions...  Long time no see...

For starters, oxygen therapy is only an abortive and not a preventative...  Moreover, the term rebound headache, actually Medication Overuse Headache (MOH), doesn't technically apply to the results of oxygen therapy as the term relates to continued, frequent and increased doses of headache pharmaceuticals, i.e., ergotamine, triptans, opioids and combination medications in particular with analgesics.

The ICHD defined MOH as a secondary headache, with the aim of emphasizing excessive drug intake as the basis of this form of headache.

What you're experiencing with oxygen therapy is an interesting phenomenon where the frequency of CH increases over a period of time if oxygen is the primary escape abortive then decreases.

We ran a pilot study of oxygen therapy at flow rates that support hyperventilation in 2007 and 2008 with seven CHers from here at CH.com.  They collected abort times and pain levels for every abort for a period of 8 weeks each. 

All seven had a green light from their PCP or neurologist to participate.  In all, these seven participants collected abort data on 366 CH aborts with this method of oxygen therapy.

Many of you may have seen one of my posts with the primary graphic that depicts the results of this pilot study illustrated below.

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What many of you may not have seen was the change in CH frequency over the 8-week period.

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All seven pilot study participants experienced a similar response pattern but participant #4's response was the most exaggerated.  As you can see the weekly frequency of his CH had doubled by the end of the second week using this method of oxygen therapy and tripled by the end of the 4th week where it started to drop.

What is also interesting was the time to abort and maximum pain level at each abort dropped steadily throughout the 8-week period.

I shared this data with the Head of pulmonology at Swedish Medical Center here in Seattle.  He checked with a cardiologist and came back with a possible explanation for the shape of this curve... 

Vascular Toning - The initial increase in CH frequency may be due to the smooth muscles lining arteries and capillaries adjusting to the frequent exercise of vascular constriction and dilation associated with the use of this method of oxygen therapy.  Then, after continued use, these muscles become stronger, i.e., toned up... so constrict faster and stay constricted longer after end of therapy.

Finally, I'd suggest getting back on the anti-inflammatory regimen if you haven't already done so.  I'd also stay on it year round.  This saves a lot of pain and the health benefits are too good to pass up.

You were one of the first CHers here at CH.com to start this regimen in early 2011 and I recall several PMs and posts discussing what to do next.

There have been a few changes to this regimen since then.  The first is a 3-month course of vitamin B 50.  Take a tablet a day for 3 months.   After that, the Kirkland brand 50+ Mature Multi has sufficient amounts of the seven B vitamins to prevent any deficiencies.

Benadryl, (Diphenhydramine) has proven effective in jump-starting this regimen if there's been no favorable response after 10 days of use.  An allergic reaction will trigger a flood of histamine that can and will make nearly every CH preventative ineffective.

Dypenhydramine is a first-generation antihistamine that crosses the blood brain barrier to block H1 histamine receptors at the genetic level. This helps prevent a reaction triggered by histamine that results in a flood of calcitonin gene-related peptide (CGRP) that has been found elevated during the pain phase of cluster and migraine headaches.  It triggers neurogenic inflammation and the pain we experience as CHers.

A week to 10 days of Benadryl (Diphenhydramine) taking 25 mg in the am and 25 mg in the pm.  Be careful not to drive while taking Benadryl as it will make you drowsy.  If you need to drive during the day, taking 50 mg in the evening is just as effective.

Trauma and surgery can also trigger inflammation and an immune response that consumes vitamin D3 and its metabolites. 

Viral and bacterial infections also trigger an immune response.  In either of the above cases, I take a 50,000 IU vitamin D3 loading dose for a couple days then double my maintenance dose for at least two weeks.

Take care and please keep us posted.

V/R, Batch

Great post Batch and thanks for the info!

I have experienced these but suggest you first exclude not staying on O2 long enough to properly abort an attack. Important to not stop when the pain subsides but to stay on it for a few more minutes when being completely pain free.