Boski,

Prednisone is the world's best-worst drug.  It is very effective as an anti-inflammatory and in halting cluster headaches, but the side effects from continued use are bad.

That's why a 10-day to 2-week prednisone taper is used primarily as a transitional therapy to prevent cluster headaches while titrating up (gradually increasing dosage up to a therapeutic level) on verapamil or another preventative.

Less than 5% of CH'ers who take the prednisone taper achieve a complete abort of their episode and nearly all the rest will experience a return of their cluster headaches when the taper is over if they haven't started on a longer term preventative.

One of the best all-round strategies on treating the cluster headache disorder includes a regimen of preventative, transitional, and abortive therapies all at the same time.  It can be found at the following link:

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The National Guideline Clearing House lists the EFNS guidelines on the treatment of cluster headache at the following link.  It includes using oxygen inhalation therapy at a flow rate of 15 liters/minute as the first abortive of choice. 

Many of us have found higher flow rates ≥25 liters/minute that support hyperventilation are far superior with faster aborts and greater efficacy than using a flow rate of 15 liters/minute.

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And yes, the intensity of cluster headaches can increase when the prednisone taper is complete if no other preventative is taken.

Take care

V/R, Batch

Boski,

If oxygen inhalation therapy didn't work for you I suspect the flow rate wasn't high enough. 

An oxygen flow rate of 7 to 9 liters/minute most frequently prescribed, only works for cluster headaches up to Kip-3 to Kip-4.   Even a flow rate of 15 liters/minute is only effective up to a Kip-5.  At pain levels above Kip-5 with any physical activity while using a non-rebreathing mask, even a flow rate of 15 liters/minute starts becoming ineffective and rarely works above a Kip-7.

Most of us need a flow rate that supports hyperventilation ≥25 liters/minute and some of us use much higher flow rates for even greater efficacy and faster aborts.

We collected data on 366 cluster headaches aborted with oxygen flow rates that support hyperventilation.  The efficacy was 99.7% and the average time to abort was 7 minutes for all pain levels between Kip-3 and Kip-9.

Take care,

V/R, Batch

Boski,

High oxygen flow rates do not cause lung damage...  That's an old wives tale. 

Navy and Marine Corps pilots have been breathing 100% oxygen while flying tactical fighter and attack aircraft from takeoff to landing for over 70 years and there have been no documented cases of lung damage.  They all get annual flight physicals with chest X-rays so any lung damage would show up if it was there... I might add that these pilots and air crew frequently breath that 100% oxygen at flow rates greater than 40 liters/minute... 

In fact, it's a US Navy regulation that all pilots and aircrew flying in ejection seat equipped aircraft breath 100% oxygen from takeoff to landing...  and they're flying $35 to $60 Million dollar aircraft...  I don't think the Navy or Marine Corps would make this a requirement if it was dangerous...

I've over 3000 hours flying Navy fighters on and off aircraft carriers, and all of that flight time was spent breathing 100% oxygen on missions lasting more that two hours and a few as long as 7 hours...  I can tell you first hand that during air-to-air and air-to-ground combat missions where high G-forces are common, a flow rate of 40 liters/minute and higher is very common... 

I'm still here at 65 and I've also been using high flow rate oxygen therapy that supports hyperventilation for more than 5 years.  With the exception of an occasional snort of imitrex nasal spray during airline travel, oxygen is all I use...  No other prescribed cluster headache medications.   I also still get annual physicals and pass them just as easy now as I did during 24 years of Naval Service.

Starting oxygen inhalation therapy at the first sign of an approaching cluster headache is the only smart thing to do.  The longer you wait, the higher the pain climbs, and higher pain levels take longer to abort.   

For example a cluster headache that reaches Kip-3 during this method of oxygen therapy will take 3 minutes to abort.  If the cluster headache reaches Kip-6 it will take an average of 7 minutes to abort and a Kip-8 will take an average of 12 minutes to abort. 

These are very repeatable results proven with the data collected by 8 cluster headache sufferers on 366 aborts with this method of oxygen therapy.  The bottom line is START OXYGEN THERAPY EARLY!

Getting hit while at work or while on the road during local travel is another issue, and yes, IQ drops rapidly when the beast starts hammering out a tattoo on the back of your eye...  However, a little prior planning and a little training makes this much less a problem as you'll gain a lot of confidence knowing you can abort your attacks with this method of oxygen therapy. 

I keep three M-size oxygen cylinders at home and I have an aluminum M60 for local travel. It holds roughly three times the volume as a 700 liter E-size portable oxygen cylinder so it's good for two to three days at three hits a day.

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My home oxygen therapy kit

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My "Roadie" that I fill myself with a transfiller rig

New York can be a problem...  but if you don't mind a ruck pack or fanny pack, you can carry two of smaller composite epoxy oxygen cylinders good for one or two aborts each and refill them at home.

The high cost of oxygen, as you put it, is a red herring...  Most M-size oxygen cylinders cost $30 per refill.  I have a 20% copay so my cost is $6 per M-size oxygen cylinder and I get an average of 30 aborts from one of these cylinders so my out of pocket cost per abort is 20 cents...  The last time I checked... an imitrex stat-pen injection costs around $80 before insurance...

If anyone was foolish enough to stay on 100% oxygen for 12 hours continuously with out any breaks breathing normal air, they would start feeling the symptoms of pulmonary oxygen toxicity, but these symptoms would clear rapidly with no lasting effects after a few minutes of breathing normal air.

Now...  With the myths dispelled and out of the way...  When are you going to give oxygen therapy another try?  I'll be glad to help.

Take care,

V/R, Batch

Boski,

Check the following link for a home oxygen delivery service nearest your location:  Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

Most home oxygen suppliers will offer a better cash price.  If push comes to shove, there's always welder's O2.  It costs a little less but there's usually the hassle of picking up the cylinder at the welders supply store.  An M-size equivalent welder's O2 cylinder will weigh 70 lbs.

You'll need a prescription for the medical oxygen.  The neurologist that writes your Rx for imitrex should be willing to give you one.  The following link provides the "How To" obtain a properly written Rx for oxygen therapy:  Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

You need an absolute minimum flow rate of 15 liters/minute but ask for a flow rate of 25 liters/minute.  If the Rx is written for 25 liters/minute you're home free...  If you only get the Rx for 15 liters/minute, you'll need to buy your own 0-25 or 0-60 liter/minute regulator.

You'll also need one of the $27.50 O2PTIMASK™ non-rebreathing oxygen mask kits.  You can order from the CH.com store at the left.

If you're having an average of 3 attacks a day, you'll need at least three of the M-size oxygen cylinders for home use for a one month supply.

The best and most economical oxygen regulators come from Flotec Inc. at:  Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or I have two of the InGage™ 0-60 liter/minute regulators.

I'll see if I can dig up a local source in the NY area for the small composite oxygen cylinders from Luxfer:  Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or .

In the mean time pick up some Jose Cuervo Margarita mix...  It's lime juice with extra citric acid and that may help bump up your arterial pH enough to reduce the frequency of your cluster headaches.

I've been drinking a couple glasses of it a night for the last two weeks and haven't had a single cluster headache the entire time...  I could lose my "chronic" status if this keeps up...   

Hope this helps,

Take care,

V/R, Batch