Denise,

If Eric is able to abort his cluster headaches at a flow rate of 15 liters/minute, the maximum flow rate a LOX system can produce without freezing up, it may be a good option.

We've done a lot of research on the use of oxygen flow rates that support hyperventilation to abort cluster headaches and found them to be superior in both efficacy and significantly shorter time to abort than a flow rate of 15 liters/minute.  For most of us, an oxygen flow rate of 25 liters/minute will support hyperventilation if we hold the physical activity to a minimum, and many of us use much higher oxygen flow rates. 

CH'ers that use this method of oxygen therapy average 7 minutes to an abort at pain levels Kip-3 through Kip-9.  I typically abort Kip-3 to Kip-4 attacks in an average of 3 to 4 minutes.  The relationship between pain levels and time to abort stays linear up to Kip-6 where the average abort is 6 minutes.  The slope starts going exponential above that with a Kip-7 taking an average of 8 minutes to abort and a Kip-8 averages 10 minutes.

All these figures are based on abort time data collected by 7 CH'ers (6 chronic, 1 episodic) who logged a total of 366 aborts using flow rates that support hyperventilation.

I start my oxygen therapy at 60 liters/minute until I push my system into respiratory alkalosis with symptoms of paresthesia present.  That usually takes 45 seconds to a minute, then I drop the flow rate to 40 liters/minute until the abort. 

I realize that sounds like a very high flow rate.  However, if you climb two to three flights of stairs at a fast pace or do some jumping jacks for 30 seconds to a minute, you'll generate a respiration rate measured in a minute volume of 50-60 liters of air inhaled (a flow rate of 50 to 60 liters/minute), just to maintain arterial CO2 at normal levels.

Oxygen flow rates this high are also very safe.  Navy and Marine Corps pilots flying fixed-wing tactical aircraft have been breathing 100% oxygen from takeoff to landing since 1942 and they still do so today flying the F/A-18s.  It's a mandatory requirement. 

As a Navy pilot with over 3000 hours flying fighters while breathing 100% oxygen from takeoff to landing, I can tell you for a fact I frequently reached minute volumes this high during air combat maneuvering where the work load while pulling 6 Gs or more in a two-minute dog fight had me breathing like a big dog...   I'm still here at 66 and I've used high oxygen flow rates like this to abort my cluster headaches since 2004 when I developed the initial procedures for this method of oxygen therapy after turning chronic.

If you decide to stick with the oxygen cylinders, ask for the M-size as they have the best bang for the buck...  I get 25 to 30 aborts out of a single iron M-size oxygen cylinder that holds 3995 liters and costs $30 before insurance. You also might consider buying Eric his own CGA-540 0 to 25 liter/minute regulator for $25 to $40 to use with the M-size oxygen cylinders.  If you want the higher flow rates you can also buy a great 0 to 60 liter/minute oxygen regulator from Flotec Inc. for around $190.

There will be times that oxygen therapy will be less effective at even the higher flow rates and that will translate to longer than normal abort times.  I've found this can be due to a lower than normal arterial pH or some kind of allergic reaction. 

I measure my saliva pH as an analog of arterial pH with pH test strips three times a day (morning prior to breakfast, noon prior to lunch, and in the evening prior to going to bed) to get a daily average.  When I go into a high cycle with increase frequency and intensity of attacks, I've measured my saliva pH and found it lower than my daily average under normal conditions.

Eric can combat the low arterial pH by taking calcium citrate tablets that also contain vitamin D3, magnesium and zinc washed down with lemonade.  I take 3 of the softgels a day.  This regiment acts as an ant-acid and buffer to elevate stomach gastric juices and ultimately elevates the low arterial pH.  Eating an alkaline forming diet of less red meat and more cold water fish also helps.

If it's some kind of allergic reaction that's causing increased neurogenic inflammation and the oxygen therapy to be less effective, I've found taking 3000 to 4000mg Omega 3 Fish Oil softgels and up to 10,000I.U. vitamin D3 a day helps reduce the frequency and intensity of my cluster headaches.  This is an anti-inflammatory regimen that works very effectively for me.

Check with Eric's neurologist before you opt for either of the two OTC regimens above.

There are a couple methods of oxygen therapy Eric can try to improve his abort times and efficacy if you opt for the LOX system.  Both methods work best if using one of the $27.50 O2PTIMASK™ kits with a 3-liter reservoir bag from the CH.com store at the left.

The first is a modified version of the above method of oxygen therapy I use except Eric will need to use the following procedures:

Take two to three very deep and very rapid breaths of room air exhaling as completely as possible between each breath, then take a deep breath of 100% oxygen and keep repeating the above sequence until the abort. 

The breathing technique is very important and it involves breathing at a forced vital capacity tidal volumes.  To do this, Eric will need to exhale as completely as possible with each breath.  When he feels like his lungs are empty, he'll need to do an abdominal crunch or squeeze like doing sit-ups and hold the squeeze for 2 seconds or until he hears a wheezing sound from his exhaled breath then inhale as deeply and rapidly as possible. 

This empties the lungs of as much breath as possible and as the end tidal flow of exhaled breath is highest in CO2 concentrations, this technique removes as much CO2 from the system as rapidly as possible with each exhaled breath. 

We've found this breathing technique works most effectively if done while standing (I lean against a wall if I feel dizzy), or seated erect to give the diaphragm a full range of motion to better ventilate the lungs.

The second option is to use a clean 40 gallon trash bag as a reservoir bag.  Obviously, it will need to be filled ahead of time and capped off with a rubber band, but it will provide over 250 liters of oxygen at unrestricted respiration rates in the first 7 minutes and that should be sufficient to abort most of his attacks if he starts on the oxygen as soon as he senses the onset of an attack if awake or as soon as possible after waking up with an attack.

Prepare the trash bag reservoir by folding the open end of the trash bag over a couple times and seal with duck tape the length of the fold for a gas tight seal. 

Cut a half inch tip off one of the opposite corners and stretch it over the lower part of the O2PTIMASK's green "T" manifold and seal with some electrician's tape for a gas tight seal.  Then cut a quarter inch tip off the other corner, insert the end of the oxygen tubing from the LOX system and tape with electrician's tape for an air tight seal.  Inflate the reservoir with oxygen from the LOX system then fold the "T" manifold over the reservoir bag and seal with a rubber band to have it ready for use.

Either method will work more effectively than a flow rate of 15 liters/minute to produce a rapid abort. 

Hope this helps.

Take care,

V/R, Batch