Hey Visperas,

Good question on the breathing technique used during oxygen therapy for the fastest aborts.  It turns out that increasing oxygen saturation with higher flow rates is only part of effective oxygen therapy to abort CH... Reducing the arterial CO2 concentration with hyperventilation is even more important if you want a really fast abort.

For starters, I discovered in 2005 that an average flow rate of 40 liters/minute produced the most effective CH aborts in the shortest time.  I can hear the wheels turning... "were did he get a regulator with that kind of flow rate?"

When I received my home oxygen therapy kit in April of 2005, the day I was Dx'd as chronic, I'd already convinced my neurologists at NIH that I would need enough oxygen on hand to abort an average of 3 CH every 24 hours for at least a week at a flow rate of 15 liters/minute...

When the home oxygen therapy truck arrived, they delivered three M-sized oxygen cylinders (3495 liters fully charged), a flowmeter type oxygen regulator and a disposable non-rebreathing mask. 

This regulator had a clear plastic bernoulli tube calibrated to a maximum flow rate of 15 liters/minute and you opened the needle valve at the base of the bernoulli tube to get the desired flow rate.  I wanted to know if it could provide higher flow rates...

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Being an old Navy fighter pilot with over 3000 hours flying high performance supersonic jets... and breathing 100% oxygen from cat shot (takeoff) to trap (arrested landing) for all of those 3000 hours... I wasn't worried about higher flow rates. 

I knew breathing oxygen at higher flow rates on flights lasting two hours or more was very safe...  so I cranked the needle valve open further to see how much oxygen that rascal could deliver...  The answer was 85 to 90 liters/minute...

It took me less than 24 hours and five cluster headaches to figure out the flow rate that worked best.  It was the highest flow rate I could sustain for the time it took to abort the the CH... which to my delight, was an average time of 4 to 5 minutes depending on the pain level...  In short, I was hyperventilating with 100% oxygen to get very rapid CH aborts.

I purchased an InGage™ 0-60 liter/minute oxygen regulator from Flotec and a Clustermasx with a 3-liter reservoir bag a year later and found the magic flow rate that worked so rapidly and effectively to abort my CH was 40 liters/minute.  I also found that flow rates down to 25 liters/minute also worked effectively... but not as rapidly as 40 liters/minute.

In late 2007 Wildhaus (Michael Berger) and I modified the procedure I'd developed with the InGage™ regulator and Clustermasx to work with an oxygen demand valve provided by Royce Fishman, Linde Healthcare. 

We tested the new demand valve procedure on the toughest nut to crack we could find... the guy with the worst cluster headaches... ClusterChuck.  Chuck was literally blown away the demand valve method of oxygen therapy worked so rapidly to abort his CH.

We needed to make sure this method of oxygen therapy worked for other CH'ers so we enlisted the aid of several CH'ers to help us evaluate this new method of oxygen therapy... 

Eventually, six more CH'ers jumped on the bandwagon with Chuck in this informal pilot study after checking with their PCP/neurologist...  They used either the oxygen demand valve or the 0 to 60 liter/minute InGage™ regulator and an O2PTIMASK kit with 3-liter reservoir bag for 8 weeks logging abort times and pain levels on every CH abort. 

The results were amazing...  The efficacy was 99% and the average abort time was 7 minutes... Both methods were equally effective for chronic and episodic CH'ers. The results are illustrated in the following graphic:

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As you can see, this new method of hyperventilating with oxygen therapy generated abort times 3 to 4 times shorter than oxygen therapy at 15 liters/minute.

We also discovered there was a direct relationship between the CH pain level at start of therapy and the abort time...  In short, the higher the pain level... the longer the abort time.  Duh! We already suspected that, but this was the first time we had the data to prove it.

Michael, Royce and I submitted a patent application to the USPTO in June of 2008 at the behest of Linde senior managment in Munich.  We subsequently traded our financial rights to this patent to Linde in exchange for the funds needed to conduct a formal pilot study of this method of oxygen therapy with Dr. Todd Rozen, MD as the Principal Investigator. 

Dr. Rozen completed his pilot study of the demand valve method of aborting CH in 2012...  The results are here at CH.com somewhere.

Linde modified their 0-15 liter/minute Linde Integrated Valve (LIV) home oxygen therapy systems to work with a demand valve.

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Unfortunately, the regulations throughout the EU, UK and Scandinavia either precluded use of an oxygen demand valve or would not cover the expense of its use under National Health Care.

Knowing that hyperventilation (breathing faster than needed) hyper-oxygenates blood hemoglobin and that it also casts off CO2 faster than the body generates it through normal metabolism, I set about developing the procedures and breathing technique needed to generate a rapid abort of a CH as fast as the demand valve method... but at an oxygen flow rate of 15 liters/minute.

Here's the procedure and breathing technique...  It's called hyperventilating at forced vital capacity tidal volumes.  You'll need an oxygen regulator capable of delivering a flow rate of 15 liters/minute and a $23 ClusterO2 kit from the CH.com store at the left... 

Take off the face mask or mouthpiece as you'll be breathing directly from the 22 mm nipple on the green "T" manifold as shown below. 

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You'll also need to cup the exhaust port in the palm of your hand and press the open breathing port to your cheek or chin when not inhaling from it to keep oxygen from escaping while you're hyperventilating with room air and the reservoir bag fills.

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Start by standing to give your diaphragm full range of movement... This is important as standing during this procedure ventilates the lungs more completely.  Lean against a wall if you get dizzy while using this method of oxygen therapy.  If you get too dizzy, sit erect in a chair.

The next step is exhale forcibly through your mouth until if feels like your lungs are empty...  they're not...  do an abdominal crunch like doing sit-ups and hold the squeeze until your exhaled breath makes a wheezing sound for a few seconds.

It sounds terrible but it's an important part of this method...  This forced exhalation breathing technique will squeeze out another half to a full liter of exhaled breath.  This last volume of exhaled breath has the highest CO2 concentration.

Then without delay, throw your shoulders back and inhale room air as rapidly and deeply as possible until you can't inhale any more.

Again without any delay, use the forced exhalation technique.  Keep repeating this sequence as fast as possible with room air for 30 seconds.  You should be able to complete three of these cycles every 5 to 6 seconds.

If you're doing this breathing technique properly, you'll start feeling the symptoms of paresthesia and a slight dizziness after 10 to 15 seconds...  The symptoms of paresthesia include a very slight tingling/prickling of the face, lips, and fingertips.  This is the best indication you've pushed your body into respiratory alkalosis.

At the end of the 30 seconds exhale forcibly one more time and hold the squeeze for a good 5 seconds...  Then place the ClusterO2 kit "T" manifold breathing port to your lips and inhale a lung full of 100% oxygen. Hold it for 10 seconds.

At the end of the 10 seconds, place the breathing port on the ClusterO2 kit to your cheek and exhale into the room.

After that do three or four cycles with room air followed by a lung full of 100% oxygen.  Keep repeating this sequence until the pain is completely gone.  You may need to increase the number of cycles with room air to allow the reservoir bag to fill completely.

I've tested this procedure in comparison to the demand valve method of oxygen therapy and the average abort time is almost as fast as hyperventilating with only 100% oxygen... The real benefit is it consumes 75% less oxygen per abort.

Practice this procedure and breathing technique with room air before your next CH so you'll get used to the sensations...

Hope this helps.

Take care,

V/R, Batch