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Oxygen treatment for cluster headache attacks at different flow rates: a double-blind, randomized, crossover study
Thijs H. T. DirkxEmail e, Danielle Y. P. Haane and Peter J. Koehler

The full paper is at the link above.


Quote:

Abstract Background Cluster headache attacks can, in many patients, be successfully treated with oxygen via a non-rebreather mask. In previous studies oxygen at flow rates of both 7 L/min and 12 L/min was shown to be effective. The aim of this study was to compare the effect of 100% oxygen at different flow rates for the treatment of cluster headache attacks. Methods In a double-blind, randomized, crossover study, oxygen naïve cluster headache patients, treated attacks with oxygen at 7 and 12 L/min. The primary outcome measure was the percentage of attacks after which patients (treating at least 2 attacks/day) were painfree after 15 min, in the first two days of the study. Secondary outcome measures were percentage of successfully treated attacks, percentage of attacks after which patients were painfree, drop in VAS score and patient preference in all treatment periods (14 days). Results Ninety-eight patients were enrolled, 70 provided valid data, 56 used both flow rates. These 56 patients recorded 604 attacks, eligible for the primary analysis. An exploratory analysis was conducted using all eligible attacks of 70 patients who provided valid data. We could only include 5 patients, treating 27 attacks on the first two days of the study, for our primary outcome, which did not show a significant difference (p = 0.180). Patients tended to prefer 12 L/min (p = 0.005). Contradicting this result, more patients were painfree using 7 L/min (p = 0.039). There were no differences in side effects or in our other secondary outcome measures. The exploratory analysis showed an odds ratio of being painfree using 12 L/min of 0.73 (95% CI 0.52–1.02) compared to 7 L/min (p = 0.061) as scored on a 5-point scale. The average drop in score on this 5-point scale, however, was equal between groups. Also slightly more patients noticed, no or not much, relief on 7 L/min, and found 12 L/min to be effective in all their attacks. Conclusion There is lack of evidence to support differences in the effect of oxygen at a flow rate of 12 L/min compared to 7 L/min. More patients were painfree using 7 L/min, but our other outcome measures did not confirm a difference in effect between flow rates. As most patients prefer 12 L/min and treatments were equally safe, this could be used in all patients. It might be more cost-effective, however, to start with 7 L/min and, if ineffective, to switch to 12 L/min.

Simply incredible that research is still ongoing with such low flow rates, especially with it resulting in the conclusion that 7lpm is better for getting people to a pain free state than 12lpm, which defies all our experience here. But it is very telling how they got to that conclusion.

They started out with 98 patients, but once they had done their exclusions to remove what they thought would impact their results, they were down to a grand total of FIVE patients. But at least they recognized that this showed the result had "little significant experience".

But sadly most medical people who will read this article will only read the abstract and use it to base their treatment of people with CH at 7lpm.

Whilst I fully appreciate that doing CH research will not be at all easy, especially when they were recruiting people who hadn't used oxygen before and seeming to focus on episodic people who naturally will experience their CH cycles ending, I have my doubts about the design of this trial, the results and the interpretation of the results based on very small sample sizes.

….COOL...an actual study addressing CH...it's so rare it makes me all squiggly...

...but then....such a TINY cohort...it's almost pointless...it makes me wanna tear my hair out....but I got no hair...so what's a fella to do? (herding clusterheads has gotta be like herding cats, and it is a puzzlement how practical a LARGE study would be?)

...so I reflect on personal experience, I guess (anecdotal evidence alert)...which would actually be a "somewhat" success WAY back in 1985... at 3-5 lpm. (no shit, and I rarely mention that, it pisses people off).  I was poor... with medical insurance that denied the existence of CH...  it was all out of pocket. slow DEEP breaths...held for as long as I could...discovered by trial and error. later went up to 12-15 (can breath no faster) which was definitely better but not game changing different. to be clear though, O2 saved my sanity...perhaps my life....

...the previous said NOT to discourage nor dispute the higher lpm's we ALL recommend....I think at minimum 15 because it IS most assuredly likely to be better... and the cost:benefit ratio (it's ONLY money and not much, especially compared to most alternatives!) makes prescribing lower flows irresponsible. just suggesting that we are all most definitely different... and we don't necessarily need to be dogma devout ....

...thank you Mike....I always appreciate your  posts on recent research...good food for thinking....

best

jon

Thanks Mike for publishing this.

It is a bit disheartening that it is such a poor study, and I take your point about it giving the wrong info to another generation of Doctors.

I would be more concerned about Clusterheads, searching in despair for anything to rid themselves of the beast, picking up on a study like this.

Peter.

Peter510 wrote on Nov 11^th, 2018 at 4:25am:

I would be more concerned about Clusterheads, searching in despair for anything to rid themselves of the beast, picking up on a study like this.

Although I suspect that most will simply Google for cluster headache oxygen.

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At least the current top spot talks about using high flow rates of up to 40lpm.

My prescription says 12, and the regs only go up to 15 anyway. 
I use 15 and it does work fine for me.  I once mentioned to the distributors that I use 15, and got a good telling off.  she told me I was abusing my prescription, and over dosing.  :-[
So now, if they ask, I tell them I use 12 but I carry on using 15. ;)