Hey Joni,
Good questions… The short answers follow:
With the exception of an occasional snort of imitrex nasal spray during airline flights, I take no cluster headache preventative or abortive medications except 100% oxygen at flow rates that support hyperventilation for my chronic cluster headaches… Instead, I take four (4) to six (6) of the calcium citrate tablets with vitamin D, magnesium and zinc as well as two to three 8oz glasses of lemonade a day as my preventatives during high cycles…
Aside from being big as horse pills, I take generally take 4 of the Kirkland brand of calcium citrate tablets with vitamin D, magnesium, and zinc a couple hours after breakfast and two more a couple hours prior to the evening meal. I get mine at Costco under the Kirkland label, but Citracal Bone Density Builder™ has nearly the same formula…
Taking twice to three times the recommended daily dosage of these mineral supplements may have contraindications with other prescribed medications you may be taking so it's best to ask your doctor prior to taking this much… I did and got a green light.
Regarding the lemonade… As strange as it may sound, the citric acid in lemonade can actually raise a low arterial pH making it more alkaline. During high cycles, I drink an 8oz glass of lemonade with lunch and two with dinner. See the charts in following links for information on lemon juice and other alkaline forming foods:
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I also make my own lemonade with 1 cup fresh squeezed lemon juice, 5 cups water & ice cubes, and I sweeten to taste with a half to three quarters cup Splenda.
Please understand this regimen doesn't work 100% of the time. Having said that, I've found it to be just as effective if not more so than any of the prescribed preventatives I've taken in reducing the frequency and intensity of my attacks. It costs pennies a day, at my age, I need the calcium with vitamin D anyway, and there are no side effects… In other words, maximum reward, minimum cost, and no risk…
I'll caveat this further by saying only a handful of us have been using this regimen. Although it's been effective, the amount of data collected is still small so any claims are still anecdotal.
Now for a longer answer with some of my logic and rationale behind using this regimen…
I use this regimen based on the simple premise that if you can measure a process, it can be managed and controlled…
Most of us use this same premise on a daily basis, but never give it a second thought. For example, when we start our car we glance at the engine instruments… No red lights… the oil pressure is up, the engine sounds good and away we go… We also watch our fuel gage and stop for gas when it gets low…
In short, we monitor the processes associated with the operation of our cars and act accordingly. There's also an implied relationship between knowing something will happen if we don't take action… i.e., if we let the fuel gage go to zero, we run out of gas and we'll need to walk to a gas station or call AAA.
Our bodies and cluster headaches also run on a series of processes except we don't have a dashboard display to monitor them…" We just know when we feel good and we know when we hurt…
If we keep track of the number of hits we have a day, we also know when the frequency of our cluster headaches is going up or down… There are also ways of measuring some of the key parameters like saliva pH as well as oxygen saturation and CO2 concentrations at home…
I measure my saliva pH with test strips from pH ION any time the frequency of my attacks start to rise… Saliva pH strips provide a reasonable indication of arterial pH. These pH measurements are slightly lower but they parallel arterial pH according to available literature… Experience has taught me if the frequency of my attacks starts going up and my saliva pH is going down, I'm going into a high cycle so I start the regimen of minerals and lemonade.
My use of this regimen as well as oxygen therapy at flow rates that support hyperventilation is based on the relationship between arterial pH and cluster headaches… When my arterial pH is low (too much acid), the frequency and intensity of my cluster headache attacks is higher (an average of 3 attacks a day)… As a result, my aborts with this method of oxygen therapy tend to take a minute or two longer.
When my arterial pH is neutral or higher than normal (more alkaline), the frequency and intensity of my cluster headaches tends to be lower (an average of 3 attacks a week). I've also gone up to 10 days without a cluster headache attack by taking 4 to 6 calcium citrate tablets and drinking 2 to 3 glasses of lemonade a day.
Although mineral supplements and lemonade appear to influence arterial pH, at least when measured with saliva pH strips… arterial pH is primarily controlled by the following chemical equation through changes in respiration rates.
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When we realized in 2007 how effective breathing 100% oxygen at flow rates high enough to support hyperventilation was in aborting cluster headache attacks, we started an informal pilot study that collected data on over 600 aborts with oxygen therapy. 366 of these aborts were collected and submitted by six participants using the new method… The results were consistent with very short abort times…
We also began researching related clinical studies to determine how and why this method of abortive therapy was so effective with very short abort times… The respiratory physiology and blood chemistry behind this method of aborting cluster headache attacks were right in front of us… All we needed to do was connect the dots.
If we remove CO2 from the blood in the above equation by hyperventilating on 100% oxygen, we lower the level of carbonic acid (H2CO3). When the carbonic acid content of the arterial blood is lowered this also elevates the arterial pH making it more alkaline. The net result is cerebrovascular constriction and more oxygen going to the brain because hemoglobin has a greater affinity for oxygen as the pH rises above normal…
The following chart illustrates the results of a related two-week study I conducted with the assistance of Michael Berger and Royce Fishman… We wanted to examine the relationships between my daily average saliva pH, saliva pH at the start of my cluster headache attacks, and the effect of aborting my attacks with oxygen flow rates that support hyperventilation on saliva pH.
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The green line on this chart represents the average pH of three measurements taken daily using saliva pH test strips. I took these measurements in the morning before breakfast, around 11 a.m. prior to lunch, and in the evening just prior to bedtime…
The red dots and lines represent my saliva pH measured at the start of a cluster headache attack. The blue dots and lines represent my saliva pH measured 5 minutes after competing aborts with oxygen therapy at flow rates that support hyperventilation.
These aborts all took 3 to 5 minutes as the attacks that woke me up from sleep were already at an average pain level of Kip-4 by the time I started on oxygen. Waiting an addition 5 minutes after the abort with oxygen therapy before taking the second saliva pH measurement allowed time for my saliva pH to equalize with my arterial pH.
I also started using a finger pulse oximeter on Day-7 of this study. I took these oximetry measurements as soon as I awoke with a cluster headache attack and again 5 minutes after the abort with oxygen therapy…
As you can see, my oxygen saturation was low at 93% down to 90% upon waking up with an attack (hypoxic), and fully saturated at 99% five minutes after completing oxygen therapy (hyperoxic).
I recently had the opportunity to measure my CO2 levels with a portable capnometer. These devices provide an indication measured in mmHg of the partial pressure of CO2 present in the breath we exhale at the end of the exhale cycle. This is called the end tidal CO2 (ETCO2) and it correlates inversely with arterial pH. In other words if the ETCO2 is high, above 45 mmHg, like it was when I woke up with a cluster headache, it indicates the CO2 level is higher than normal. That's also a clear indication my arterial pH is low.
Under normal conditions, ETCO2 is generally close to 40 mmHg. After aborting a cluster headache by hyperventilating on 100% oxygen my ETCO2 was between 20 and 30 mmHg indicating I'd cast off sufficient CO2 to raise my arterial pH and push my system into respiratory alkalosis.
The following graphic illustrates relative vasoactivity associated with variations in oxygen concentrations, pH, and CO2 concentrations…
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As you can see, if you push all three measurements up into the green by hyperventilating on 100% oxygen and holding it there for 2 to 4 minutes, you're doing everything you can to stimulate vasoconstriction and that should result in a very short and very reliable abort of your cluster headache attacks.
There's a corollary to "three in the green" on the above chart where you get rapid and reliable aborts…
For example, if you breathe oxygen therapy at 7 to 9 liters/minute or even as high as 15 liters/minute to abort a cluster headache attack, you'll push your oxygen saturation up to nearly 100%.
However, if your level of physical activity is higher than normal, i.e., dancing in circles or rocking back and forth pounding on the side of your head, you'll generate more CO2 than if you were sitting quietly. If the volume of lung ventilation is restricted to the regulator flow rate and the use of a non-rebreathing mask, there may be insufficient lung ventilation to keep CO2 levels in the normal range and CO2 levels will build above normal.
When that happens, arterial pH will also drop and hemoglobin will carry less oxygen to the brain. At that point you'll have one in the green and two in the red… and that means the probability of a successful abort with oxygen therapy will be low to nonexistent…
Hope this helps and the long answer wasn't too long.
Take care,
V/R, Batch
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