Hey JL,

Good on you for quitting smoking in order to get your neurologist to give you an Rx for oxygen therapy.  I think it's criminal to refuse oxygen therapy to cluster headache sufferers...  but then you did quit smoking... 

It sounds like you're using your oxygen therapy properly.  Pattern changes in the frequency of cluster headache attacks are not uncommon after starting oxygen therapy.  Most new users have what we call re-attacks where another attack will occur 15 to 45 minutes after a successful abort with oxygen therapy. 

Re-attacks happen when the oxygen therapy works so well and so fast it aborts the pain of the attack, but not the triggering mechanism.  When the effects of the oxygen therapy wear off and the triggering mechanism is still present, the attack resumes...  Re-attacks tend to go away after 3 to 4 weeks if folks use oxygen therapy on every attack.

The frequency of your attacks should start dropping in a few weeks as well if you maintain the practice of using your oxygen therapy on every attack no matter how minor.  We saw this as a consistent pattern in the pilot study we ran where we collected data on over 650 aborts with oxygen therapy.

My attacks hit like clockwork every two hours from 8 pm to 6 am for the first 10 years while I was episodic, so I didn't notice any difference when I turned chronic and finally started using oxygen therapy...  All I knew at the time was I was getting fast aborts with oxygen therapy in less than 7 minutes without any of the side effects of maxing out on imitrex each night.

I found that taking half a 50mg imitrex tablet after aborting the last hit with oxygen before going to bed helped me get the needed sleep...  The half life of imitrex is 2 hours and a 25 mg dose would still be at a therapeutic level after two hours so this regimen would usually give me a minimum of 4 hours sleep...  and some times 6 hours during peak cycle time.

With the exception of an occasional snort of imitrex nasal spray during air travel, I no longer take any cluster headache preventatives or abortives.  I quit taking them when I found that oxygen therapy worked even faster when the flow rate supported hyperventilation.

I still have high and low cycles that just happen for no apparent reason.  During high cycles I average 3 to 4 attacks a day and 3 to 4 a week during low cycles. 

It appeared my high cycles were due to a drop in arterial pH so I started logging my saliva pH measurement 3 times a day and at the start of each attack as soon as I woke up. 

The following chart shows a clear drop in my saliva pH at the start of each attack shown in red below the daily average shown as the green line...  All of these attacks hit while sleeping.

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I took the second pH measurement shown in blue five minutes after the abort with oxygen therapy to give my saliva time to equalize with arterial pH.  As you can see, the oxygen therapy pushed my saliva pH back up to or above the daily average pH.

I also used a finger pulse oximeter to measure my oxygen saturation as soon as I woke up with an attack and again 5 minutes after the abort with oxygen therapy starting on Day 7.  As you can see my oxygen levels were low when waking up with an attack.  The normal range is 96% to 98%.  You can also see that five minutes after oxygen therapy, my oxygen levels were still at 99%... That's as high as my finger pulse oximeter will register.

Armed with this information, I started taking 4 to 6 calcium citrate tablets with vitamin D, magnesium, and zinc each day as a preventative...  These mineral supplements act as a buffer that elevates a low arterial pH back up to neutral.  They don't prevent my attacks completely, but they do reduce their frequency from one a week to as much as one in ten days.

I also found that drinking an 8 oz glass of fresh lemonade with lunch and two more with the evening meal helped reduce the frequency and intensity of my attacks.  I know it sounds counterintuitive as lemonade contains citric acid, but lemonade actually elevates arterial pH...

The following link explains more about the body's acid-alkaline balance.  There's also a chart near the end of this link that shows alkaline forming foods:
 
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I order my pH strips from pH ION at the following link:

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Take care and keep up the oxygen therapy.

V/R, Batch

(Except when we need to switch vehicles and I forget. But forgetting can sometimes be a good thing as it means I haven't thought about it in awhile.)