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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Oxygen Therapy Q&As 
        
(Message started by: wildhaus on Mar 9^th, 2008, 10:07am)

Title: Oxygen Therapy Q&As
Post by wildhaus on Mar 9^th, 2008, 10:07am

Lately I have noticed an increase in O2 related quotations, on several boards,
This is an extract from briefings on Oxygen Therapy by Michael Berger and
Pete Batcheller (mostly Pete) with the help of some members of this little world of ours,
and presented to neurologists and other medical professionals
treating Cluster headache sufferers.
We hope this might answer some of the questions about O2

Pete & Michael.

Oxygen Therapy Q&As

The following questions and answers were extracted from briefings on Oxygen Therapy by Michael Berger and Pete Batcheller and presented to neurologists and other medical professionals treating cluster headache sufferers.

The following is provided for information purposes only.

Do not attempt any of the following treatments without direct supervision of your physician or neurologist.

What causes cluster headache attacks?

Medical science has yet to identify the cause of cluster headaches or the triggering mechanism that starts each attack and keeps it going. Neurologists and researchers have found that the hypothalamus plays a role and that some kind of vasoactive triggering mechanism causes the arteries and capillaries in and around the trigeminal nerve to dilate. Why the pain of a cluster headache attack happens mostly on one side of the head and not both remains a mystery. Some researchers theorize the initial pain of a cluster headache attack may come from sensory nerves lining the arteries and capillaries nearest the trigeminal nerve and somehow spread to the branch of the trigeminal nerve signaling severe pain in the areas around and above the eye, sinuses, and jaw.

The three treatment strategies for both episodic and chronic sufferers include medications that act as preventatives, abortives, and a transition strategy of medications used for short periods of time while waiting for the preventatives to start working. As cluster headache sufferers are all wired differently, no single medication or combination of medications produces consistent results. When the efficacy of the preventative and abortive medications are unable to bring relief after several combinations have been tried, the chronic cluster headache sufferer is considered intractable.

Why use oxygen therapy as an abortive for cluster headache attacks?

A combination of oxygen therapy and imitrex is the most commonly prescribed abortive strategy. Of these two treatments, oxygen has proven to be the safest, most cost effective, and least invasive abortive treatment for most people suffering from cluster headache attacks. Moreover, the side effects associated with oxygen therapy are low to non-existent when compared to other prescribed cluster headache medications in use today.

What flow rates are used during oxygen therapy for cluster headaches?

Most doctors and neurologist currently prescribe medical oxygen at a rate of 7 to 10 liters per minute. However, a growing number of neurologists familiar with study results published by Dr. Todd Rozen, MD, in 2004, have started to prescribe oxygen therapy at 12 to 15 liters per minute. Dr. Rozen is a leading neurologist who specializes in cluster headaches at the Michigan Headache & Neurology Institute (MHNI) in Ann Arbor, Michigan. He found that some cluster headache suffers that did not respond to oxygen therapy at 12 liters per minute were able to abort or shorten the length of their cluster headache attack by breathing 100% oxygen at a flow rate 15 liters per minute. He further concluded that even with intractable cluster headache sufferers, neurologists should try a treatment strategy that includes oxygen therapy at a flow rate of 15 liters per minute prior to trying more invasive treatments.

How does oxygen therapy work as a cluster headache abortive?

Oxygen therapy works as a cluster headache abortive because it elevates the amount of oxygen absorbed by hemoglobin in the red blood cells above normal levels as they pass through the lungs. The term used in respiratory physiology for this temporary condition is called hyperoxia, and hyperoxia has been know for many years to act as a vasoconstrictor. Like imitrex, hyperoxia causes the muscles lining the arteries and capillaries to constrict reducing the diameter of these blood vessels. The level of constriction is more pronounced in the cerebrovascular system than elsewhere in the body.

As cluster headache pain is associated with cerebrovascular dilation in and around the trigeminal nerve, any vasoactive agent that constricts these blood vessels back to a normal or smaller diameter appears to be part of the mechanism that aborts the pain of a cluster headache attack. Preliminary studies have shown that the higher the oxygen therapy oxygen flow rate, the lower the time required to abort the pain of a cluster headache attack. These same studies have also clearly demonstrated that the higher the level of pain during a cluster headache attack; the longer it takes to abort the attack with oxygen therapy. For example, a cluster headache at Kip-6 may take as little as 6 to 10 minutes to abort using an oxygen flow rate of 15 liters per minute, but an attack at Kip-8 or Kip-9 could take 30 minutes or much longer at the same oxygen flow rate.

What is hyperventilation?

Hyperventilation is a physiology term describing the process of ventilating the lungs at higher than normal respiration rates. Simply put, breathing much faster than normal.

What is the normal respiration rate?

At rest, the normal adult respiration rate is 15 to 18 inhale-exhale cycles per minute. With a tidal volume of a half-liter, that works out to a flow rate of 7 to 9 liters of air per minute moving in and out of the lungs. During hyperventilation, the respiration rate is much higher than normal and so is the tidal volume.

At what respiration rate does hyperventilation start?

Although the onset of hyperventilation varies due to body size, age, and other factors such as smoking, a flow rate of 24 liters per minute is a good low average for people to start feeling the effects of hyperventilation. This works out to a hyperventilation rate of 24 inhale and exhale cycles per minute with an average tidal flow of one liter.

What happens to our body when we hyperventilate?

The primary effect of hyperventilation is expelling or casting off CO2 faster than the body produces it. Most of us are familiar with the symptoms of hyperventilation including dizziness, a tingling of the lips and extremities, and possible visual disturbances. All these symptoms clear rapidly in less than a minute when you stop hyperventilating. Hyperventilation drives the body into a voluntary condition called respiratory alkalosis. As hyperventilation reduces CO2 in the bloodstream and as CO2 dissolved in the blood becomes a weak acid, lowering the CO2 shifts the pH upward from slightly acidic to slightly alkaline. Another name for this condition is called hypocapnia meaning lower than normal levels of CO2 in bloodstream. Hypocapnia is also a vasoconstrictor.

What happens when we hyperventilate on 100% oxygen?

Three important things happen that are particularly beneficial for cluster headache sufferers when they hyperventilate on 100% oxygen. (1) The oxygen levels in the arterial bloodstream rises to 100% saturation (hyperoxoia). (2) The CO2 level in the bloodstream falls (hypocapnia). Remember, both hyperoxia and hypocapnia are vasoconstrictors. And (3), an elevated pH increases hemoglobin’s affinity for oxygen enabling each blood cell to carry more oxygen to the brain than possible at a flow rate of just 15 liters per minute.

The resulting combination of hyperoxia, hypocapnia, and an elevated pH above 7.4 that superoxygenates arterial blood flowing to the brain all serve to constrict the arteries and capillaries in and around the trigeminal nerve aborting the pain of a cluster headache attack much faster than the traditional oxygen flow rates that do not support hyperventilation. It’s important to know that even with cerebrovascular constriction and a slightly reduced arterial blood flow, several studies have shown the oxygen content in brain tissues is actually higher under these conditions.

How much is enough when hyperventilating on 100% oxygen?

The simple answer is we don’t know. The results of preliminary studies are largely anecdotal due to a limited sample size, but they are very promising with no adverse effects. We expect the answer to this question and many others in 2008. A larger clinical study of this therapy is in the final planning stages with a more than sufficient number of study participants planned.

Title: Re: Oxygen Therapy Q&As
Post by RichardN on Mar 25^th, 2008, 11:01am

Would appreciate comments re this article.

I personally don't care WHY it works for me . . . and so many others here . . . just VERY grateful it does.

However, if 100% 02 produces the three conditions mentioned (all of which are vasoconstrictors) . . . might be another study to include in those materials we copy and take to the docs.

Your thoughts?

Be Safe, PFDANs

Richard

Title: Re: Oxygen Therapy Q&As
Post by DragonSlayer on Mar 25^th, 2008, 5:59pm

on 03/25/08 at 11:01:08, RichardN wrote:

I agree it is good info Richard.

Might have a problem with Dr.'s
because there are no medical studies cited. :(
Dr. may dismiss it as just a lay-person's writing. >:(
IMHO

Title: Re: Oxygen Therapy Q&As
Post by Batch on Mar 25^th, 2008, 7:52pm

Richard,

We developed the Oxygen Therapy Q&As based on an 18 month long analysis of research articles, related studies on the physiology of oxygen therapy, the Navy's Hyperbaric Oxygen Therapy, the Naval Flight Surgeon's Manual, and a compilation of personal diary logs of cluster headache abort times using oxygen therapy. As Michael and I are not doctors, the present Q&As are for information purposes only and would be considered anecdotal at best by most neurologists.

One of the more authoritative sources of information you can take to your neurologist regarding oxygen therapy as an abortive for cluster headaches comes from the Michigan Headache & Neurological Institute (MHNI), Ann Arbor, MI. If you want or need something in the near term to take to your neurologist that supports a prescription of oxygen therapy as a cluster headache abortive, take a look at the following links:

http://www.mhni.com/faqs_high_oxygen.aspx

http://www.mhni.com/ArticlesHtm/HighOxygenFlowRates.htm

With a little luck, there will be more information available in July at the OUCH 2008 Convention in Dallas.

Take Care,

V/R, Batch

Title: Re: Oxygen Therapy Q&As
Post by jon019 on Mar 25^th, 2008, 8:21pm

Wow, this is REALLY interesting!

I have personally achieved "success" (60-90% of the time depending on time in cycle) using 6-8 l/m. Attempts at higher l/m didn't seem to make any difference. Now I'm wondering if it was because I wasn't doing it right.

My whole philosophy was to breath O2 low and slow, (15 l/m, that's just a waste) as part of dealing with the hit. To calm myself down, fight the panic, concentrate on something, anything, other than the pain. The emotional and physical benefit of this has been incalculable. Even w/o the O2, it has been beneficial. I won't, I can't, give that up (not yet anyway).

However, after reading this, well, the more I think I know about ch, the less I actually do. Just one more reason to be here.

Thank you wildhaus, now you got me thinking.

Regards,

Jon

Title: Re: Oxygen Therapy Q&As
Post by CostaRicaKris on Mar 25^th, 2008, 10:19pm

My prescription is for 10 lpm, but I have found that has no effect. I can abort an attack with 6-10 minutes of use at 15 lpm, so that's what I use.

Title: Re: Oxygen Therapy Q&As
Post by DragonSlayer on Mar 25^th, 2008, 11:00pm

Hey Batch

Thanks for the effort!!! That report has the best info on O₂ you will find.

Knowledge is power when it comes to fighting this beast. [smiley=bigguns.gif]

[smiley=bow.gif] Thanks again to both you and Michael!! :)