Sorry it’s taken so long to respond to this post. As some of you have probably figured out, I’ve been kind of busy…

First of all, let's not go pole-vaulting over mouse turds... There is nothing wrong with posting articles and studies like this on CH.com.  That’s why CH.com is here.  Having said that, using a single article like this as the basis of an opinion one way or the other about using oxygen therapy and making it a “Please Read” is irresponsible and risky at best.  A “WTF Over” would have been more appropriate.

If you want to be really helpful, be critical in what you read.  And, if you find something of interest you think is worth passing on to others, search the Internet for as many similar articles and studies as possible to see if there are differing positions or findings contrary to the original article or study before you choose to assume it is the only authoritative source of information on that topic.

With respect to the article you posted…  Using 100% oxygen therapy as an abortive for cluster headaches is diametrically opposed to providing life support resuscitation to a person unable to sustain spontaneous respiration.  In simple words… a big, big, difference.  

I was on a dive boat in the Channel Islands off Long Beach, CA when a fellow diver was pulled to the surface unconscious and not breathing.  Several of us performed mouth-to-mouth resuscitation for several minutes and managed to get him breathing on his own and although unconscious, stable with good color.  A rescue copter met us and lifted him in a litter for the flight back to the nearest facility with a hyperbaric chamber.  

As soon as the paramedics had him onboard the copter, they strapped a non-rebreather oxygen mask to his face similar to the masks we use, and provided him with 100% oxygen.  At some point during the flight the paramedics noticed the lack of spontaneous breathing and started bag mask procedures with 100% oxygen. It wasn’t until late that night that we found out he died enroute to the beach.

The cause of death was listed as hypoxia…  lack of oxygen.  It took a few months, but the final report indicated that resuscitation with 100% oxygen, although an accepted procedure at the time for an unconscious victim not breathing on his own, prevented sufficient CO2 from entering the divers lungs to stimulate spontaneous respiration.

Before you run around the room saying “Gotcha” remember the basics of using oxygen therapy as an abortive for cluster headaches.  No Straps!  Cut the straps off the NRB oxygen mask and hold it in place during therapy.  The main reason for this is to prevent suffocation (hypoxia) should the oxygen supply run out while the mask is strapped to your face and you happen to fall asleep.  Understand also, that if you are unconscious, and incapable of spontaneous respiration, a cluster headache would be the least of your worries.

Getting back to the article…  If you really understood the results of the underlying study and read it in context with basic respiratory physiology, the article would have no bearing on your continued use of oxygen therapy as an abortive for your cluster headache attacks.   In my opinion, the results of the actual study, not the article, would actually reinforce your use of 100% oxygen as a cluster headache abortive.

The topic of this article, one of many I might add written about the same study, has come up in the past here on CH.com.  I, and several others responded to it then. You need to understand this article is a dramatization written by an RN on a mission, not the complete scientific study presenting all the results and conclusions of the principal investigator(s) in context.  I’ve read the actual study and found the results consistent with several other studies on the physiology of respiration with 100% oxygen.

Respiratory Physiology 101 Factoids For Cluster Headache Sufferers Using Oxygen Therapy

Note: The following factoids come from respiratory physiology texts, the Naval Flight Surgeons Manual, and several corroborating clinical studies listed in the Journal of Applied Physiology and the Canadian Journal of Anesthesia.  You might want to read the full text PDF of the study at the following link as an example: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

1.      100% oxygen is your friend and CO2 is your enemy.

2.      100% oxygen when used as an abortive for cluster headaches is very safe.  
   a.      Navy and Marine Corps pilots flying tactical aircraft have been breathing 100% oxygen for over 60 years.
   b.      Many of these missions are greater than two hours in duration.  Some missions last 7 or more hours.
   c.      The Navy has been studying the effects of breathing 100% oxygen for over 60 years (the most authoritative study of its kind with tens of thousands of participants)… and found no ill effects.
   d.      The Navy still requires Navy and Marine Corps pilots to breath 100% oxygen on every mission in tactical jet aircraft.
   e.      As a Navy pilot with over 3000 hours flight time in fighter aircraft, and all of it breathing 100% oxygen, I can assure you there were hundreds of times where I would suck down 100% oxygen at flow rates over 50 liters/minute…  I’m still here.

3.      CO2 levels control your respiration rate not oxygen levels.

4.      100% oxygen is a vasoconstrictor and CO2 is a vasodilator.

5.      A CO2 level above normal (hypercapnia) acts as a more powerful vasodilator than 100% oxygen (hyperoxia) does as a vasoconstrictor.  However, if CO2 is reduced from the bloodstream below normal levels (hypocapnia) by hyperventilating on 100% oxygen, this condition acts as an even more powerful vasoconstrictor than hyperoxia.  This will also result in faster aborts of cluster headache attacks…  As much as three times faster.

6.      The cluster headache triggering mechanism results in among other things, vasodilation of the cerebrovascular systems in and around the trigeminal nerve as well as inflammation of the trigeminal nerve itself.  This is why abortives such as triptans and 100% oxygen are prescribed.  They act as vasoconstrictors to counter the vasodilation, constrict these arteries back to a normal diameter, and reduce the inflammation of the trigeminal nerve to abort the pain of the cluster headache attack.

7.      Using an oxygen flow rate of 7 to 9 liters/minute with a properly functioning non-rebreather mask will limit the minute-volume (the volume of oxygen inhaled in one minute) of respiration to 7 to 9 liters.
 
8.      During the physical activity associated with high Kip-level attacks, using a properly functioning NRB mask and an oxygen flow rate of 7 to 9 liters/minute may not provide sufficient lung ventilation to cast of excess CO2.  If this happens, CO2 levels in lungs and bloodstream will rise above normal, that leads to hypercapnia, and that can and will make an abort impossible. (Just watch the reservoir bag on the NRB mask Chuck was using in his video.  It’s collapsed most of the time.)

9.      A 100% oxygen flow rate above 30 liters/minute (minute-volume greater than 30 liters) is required to sustain hyperventilation.  Moreover, hyperventilating on 100% oxygen will result in a significantly higher success rate and a 2:1 to 3:1 reduction in abort times when compared to oxygen therapy at 15 liters/minute

10.      Inhaling a mixture of 98% oxygen and 2% CO2 as an abortive for cluster headaches can easily result in vasodilation, much longer abort times. and may even prevent the abort.
   a.      Here’s a simple test you can try if you choose not to believe factoids regarding CO2.  Get a big paper bag, and breathe into and out of it for 15 to 20 seconds.  You should notice an uncontrollable urge to breathe faster followed by a growing sense of anxiety and eventually panic attacks.  I wouldn’t try this during a cluster headache attack unless you want to spike a very big one…

I could go on, but these are the basic factoids regarding the use of oxygen therapy to abort our cluster headache attacks.  As usual, and in keeping with the basic disclaimer, I’m not a doctor so consult with your GP and/or neurologist before attempting any of the above.  

I also welcome comments and if you find issue with any of the factoids, please cite at least one or two studies to reference the issue so we can discuss them.

Take care,

V/R, Batch

Hey Jim,

Great comeback...  and there was nothing personal in my response...  It's hard enough to get folks to try the single most effective, least expensive, and least invasive abortive available as it is without having an observation or statement hit the boards that could spook the undecided.  So...  I try to short-stop any potentially misleading or questionable information as soon as I see it and place it in perspective so folks can make their decisions with as many facts as possible.

Like I said, this is what CH.com is all about.  With respect to finding the good stuff, when there's been a significant response or post worth keeping, DJ and Steph will usually move it up to the permanent area at the top of each forum.  Good places to go if you're looking for information that's passed the sniff test.

We're all learning and we can't stop until the beast is exposed and sent away for good.  Until then, it's headzup and eyezon looking for the better treatment strategy until medical science comes up with the real cause and a cure for our disorder.

Hang in there and take care,

V/R, Batch