New CH.com Forum - Print Page

So the oxygen is working for me but I feel like it's really inefficient lately. Sometimes I'm blowing through a whole E tank or even more at 25 lpm just to kill one hit.

Not sure if I'm doing something wrong. Using an O2ptimask and trying to hyperventilate as quickly as possible. Can someone give me a step-by-step technique I should be utilizing?

May want to turn down the flow until you find your minimum effective flow rate. For some hi-flow is a must. For me, I can kill an attack in less than 10 minutes at 7 lpm.

BTW - I grew up in Granada Hills. Ex Valley Boy here.

Thanks Bob. I was originally using a 15 lpm regulator but that wasn't working for me at all. 25 lpm is working but it's just taking a very long time and I'm going through a lot of oxygen. Maybe the beast is just being particularly stubborn during this cycle.

Btw, I grew up in Chatsworth :)

I am no expert in higher flow rates, but could you maybe need a slightly HIGHER flow rate that might kick it using less actuall O2?

In MY experience, Eric is on the right track. I also used waaay more total O2 trying to kill CH's with low flows. Now, I use less total O2 at very high flow rates because it works so darn fast.

An E tank holds roughly 680 liters. At 25 lpm, you are pushing 30 minutes of use - too long.

I generally can hyper ventilate at about 45 lpm (sometimes much higher is required) but it only takes 3-6 minutes. The attacks that occur about 45 minutes after I fall asleep take 5-6 minutes to kill, but it's very hard to force myself to breath faster than 45 lpm.

The daytime hits are almost always gone in 3 minutes because I'm on my feet ripping away at full flow. Fear of what is about to happen if I don't, is a strong motivator.

Over the long haul, I would estimate that I use about 250 liters per CH.

Yes, people react to O2 therapy differently but for ME, using very high flow rates also reduces the "re-hits" over time. In other words, when using a lower flow rate, I tend to get more hits.

The time to kill a hit is very, very important to me because I am a zero to K10 in 5-7 minutes person. The difference between 3 minutes and 8 minutes is inconvenience vs. sheer pain. Once the pain gets high, it is much harder for me to kill.

Again, folks react differently to O2. Bob is a good example: He's bigger than I am, but he has a long history of doing very well with very low flow rates.

The ability to have virtually unlimited flow and lots of oxygen in huge tanks has radically changed my life. For what it's worth, each CH costs me about 50 cents worth of O2 to abort using welding O2.

Marc

Yea, I'm thinking about biting the bullet and getting a 0 to 60 lpm regulator. Thought I could get away with the cheaper 25 lpm but I guess not.

Have you tried cranking it down to a low flow, then breathing slowly?

Yup, I've tried 15 lpm, 10 lpm and 8 lpm. Still no dice lately.

Slacker,

Flow rates of 25 liters/minute and above are the only way to fly when using oxygen therapy to abort your attacks... Breathing 100% oxygen at flow rates that support hyperventilation is the only sure way to abort your attacks rapidly, reliably, and safely... 25 liters/minute is the minimum flow rate to do that... Moreover, this method of aborting our attacks is far more effective, safer, and less invasive than other prescribed abortives.

In keeping with the accepted practice… the following is for informational purposes only and should not be attempted without first consulting with your primary care physician or neurologist… if you’re lucky enough to have one or the other that understands what I’m talking about…

Read and judge for yourself.

Take care and have a wonderful Thanksgiving.

V/R, Batch

Any flow rate less than 25 liters/minute does not provide sufficient lung ventilation to reduce CO2 levels below normal in order to support fast and reliable aborts. You also need more than a few E-size oxygen cylinders to do that, as my little friends who visit our deck each night already know…

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to

END PRINTPAGE

Most folks don't realize that there are two parts to effective oxygen therapy in aborting our attacks:

(1) Increasing the oxygen content of the arterial blood, and

(2) Decreasing the CO2 content of the arterial blood.

If you're breathing oxygen at too low a flow rate, you can still satisfy Part 1, but you’ll likely fail to satisfy Part 2. Moreover, if the lung ventilation is constrained by using a non-rebreathing mask at too low an oxygen flow rate, arterial CO2 levels can actually rise. When that happens, an abort will be difficult at best if not impossible.

It turns out that a high CO2 level (hypercapnea) is a more powerful vasodilator than a high O2 level (hyperoxia) is as a vasoconstrictor. In short, even if you're breathing 100% oxygen, the CO2 levels will still climb if the lung ventilation is not sufficient to keep CO2 at normal levels or below. If this sounds confusing, measure your respiration rate at rest, then run up a couple flights of stairs and measure it again…

You should see an increase in respiration rate from 12-15 up to 20-25. When you figure the tidal volume of air inhaled with each breath at rest is a half to three quarters of a liter, and after the exertion of rapidly climbing the stairs where the tidal volume increases to 2 liters, that makes the effective flow rate at rest between 9 and 12 liters/minute… and after you run up the stairs the effective flow rate is 40 to 50 liters/minute… That’s a big difference!

Why? Simple… It’s not the lack of oxygen that makes you breathe faster after physical exertion, it’s the excess CO2… and your body controls CO2 levels by changing the respiration rate… If your CO2 levels are higher than normal… CO2 receptors tell your body to breathe faster to lower the CO2 level back to normal… and you have no say in the matter…

Oxygen cylinders… If you're having three or more attacks a day you should have at least 3 M-size 3995 liter oxygen cylinders on hand as a month's supply. The only reason I kept an E-size cylinder around was for local travel and work... The following photo shows my oxygen therapy rig…

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to

END PRINTPAGE

As you can see from the photo above, I’ve got a month’s supply with 3 of the M-size cast iron oxygen cylinders, and that I also prefer the mouthpiece over the facemask on both the demand valve and O2PTIMASK™… I’ve flown over 3000 hours in Navy fighters and all of that flight time with an oxygen mask strapped to my face and helmet so I’m no stranger to either method…

The O2PTIMASK™ kit comes with both mouthpiece and facemask so give both a try and see what “feels” and works best for you…

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to

END PRINTPAGE

I've since replaced the E-size oxygen cylinders with a Luxfer aluminum M60 that holds 1700 liters of oxygen. I also picked up a trans-filler rig so I can refill the M60 out of the M-size cylinders... At 23 lbs, the M60 is only slightly heavier than the E-size cylinder but it’s got over two and a half times the oxygen content… As both the cast iron M-size and aluminum M60 have the same CGA-540 attach fitting, I only need one CGA-540 regulator…

Like anything else with cluster headaches, we're all wired differently and some folks can get by with lower flow rates up to a point... And that point is simple... If you're not achieving an abort in an average of 7 minutes at pain levels between 3 and 9, the flow rate is too low or your breathing technique sucks...

Why 7 minutes? The 7-minute figure comes from a study we ran from August of 2007 through September of 2008 with 9 volunteer cluster headache sufferers using either a demand valve or high flow rate oxygen regulator with an OP2TIMASK™. The participants collected data on over 600 cluster headache aborts with no adverse effects and no complaints. 366 of these aborts used flow rates that supported hyperventilation…

Unlike the global warming hoax were a few corrupt people fudged or “cooked” the data to meet their misguided political and ideological goals in order to say the earth was warming when it appears it wasn’t, the participants in this study collected their own data. The six that used the therapy procedures correctly know full well the efficacy of this method of oxygen therapy… I'll wager they'll be more than happy to tell you just how well it works if you ask them.

The success rate using this method of oxygen therapy was 99.7% with an average abort time of 7.0 minutes for all attacks between pain level 3 through 9 on either the Kip-Scale or the Johns Hopkins 10-point headache pain scale. The remainder of the aborts involved normal respiration rates that didn’t support hyperventilation or an oxygen flow rate of 15 liters/minute… The average abort time there was 23 minutes… You do the math and decide for yourself…

We'll have more to say about the results of this pilot study once Dr. Todd Rozen, Geisinger Neurosciences Institute PA, reports the results of his study of this method of oxygen therapy early next year.

How you administer oxygen therapy is very important… Most folks do their oxygen therapy seated and hunched over with their elbows on their knees... That's the worst possible position... I've found that standing or sitting erect takes pressure off the diaphragm giving it a full range of motion to better ventilate the lungs...

When you look at the mechanics, all this starts to make sense... The average adult lungs hold 5 liters of air or oxygen when fully inflated... The maximum tidal volume you can inhale after exhaling completely is around 3 liters... That leaves 2 liters of residual breath remaining in the lungs at all times... and that 2 liters contains the highest concentration of carbon dioxide (CO2).

The best breathing technique for oxygen therapy involves inhaling as deeply as possible then exhaling as deeply as possible... except when you think you’ve exhaled as much as possible… do an abdominal crunch like you’re doing a sit-up. This forces the diaphragm up into the chest cavity squeezing more of that residual 2 liters of breath out of the lungs…

If you’re breathing correctly, the abdominal crunch should make a wheezing sound as you squeeze out residual breath. In short, squeeze ‘till you wheeze… Repeat this 3 or 4 times then increase the respiration rate inhaling and exhaling as deeply and as fast as possible without collapsing the 3-liter reservoir bag or letting it fill too tight.

You’ll know when you’re breathing correctly and at a fast enough rate when you start feeling the symptoms of paresthesia, a slight sensation of dizziness with a prickling or tingling sensation of the fingertips, face, and back of the neck…

This is a GOOD SIGN so don’t get spooked… The symptoms of paresthesia indicate you’ve hyperventilated long enough to reach respiratory alkalosis and that’s what makes the aborts come faster than anything else… It’s also very safe.

If you get uncomfortable standing when you feel the slight dizziness, lean against a wall or sit erect in a chair. I’ve sucked down 100% oxygen at flow rates that were high enough to flap my shirttail without any problems… I’ve done this on a near daily basis for over 4 years and I’ve yet to fall on my backside…

You can give the above a try after consulting with your PCP or neurologist… or… you can wait for free social medicine courtesy of Harry and Nancy’s Trillion dollar version of Obamacare behind curtain number 3. I hear they'll have medical trainees imported from the Tayna Reserve, University of the Congo and that these clever rascals will practice bureaucratically controlled outcome-based medicine without need of a board certified physician…

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to

END PRINTPAGE

We hear this fellow works for bananas, has progressive bedside manners, and he’s developed a novel method of attaching oxygen regulators where you would least expect…

Cheers...

I am so going to show this to my neuro!

Thanks

PFDAN
jrcox

Batch doth know of what he speaks! ;)

Joe

Quote:

Flow rates of 25 liters/minute and above are the only way to fly when using oxygen therapy to abort your attacks... Breathing 100% oxygen at flow rates that support hyperventilation is the only sure way to abort your attacks rapidly, reliably, and safely... 25 liters/minute is the minimum flow rate to do that

False. Be careful when stating absolutes.

added: Made me wonder if these effects, described by Batch, could be achieved with medication? I've taken Diamox to avoid altitude sickness. It increases the acidity of the blood to help it transport more oxygen. Is there benifit in increasing the alkalinity of the blood with some knid of medication (the Andromida Strain, maybe we should drink Sterno)?

But I can abort in 5 - 7 minutes at 15LPM every time?

Bob and I have discussed this at length and I've come to the radical conclusion that folks respond differently to O2 - wow, what a thought.

Fortunately for me, I discovered that very high flow is just short of miraculous for me. I had given up on O2 because "it didn't work" when I had a lower flow regulator.

My CH's ramp up very, very quickly so a few minutes in the abort time is a really big deal to me. With high flow rates, they never have a chance of getting high on the Kip scale because they are killed in 3-6 minutes.

It is important that both sides of the O2 story be explained to new folks in particular.

I can't stand the thought of someone potentially enduring agony simply because they didn't know that they MAY need high flow. Think of all the people who have come here and said that they tried O2 in the past - but it didn't work........

Respectfully,
Marc

Batch/Marc/Anyone with any thoughts....

Gary continues to not be able to abort attacks with 02.

He is clearly someone for whom the 02/C02 exchange is a problem with the C02, as physical activity is a major trigger.

He's been on high quality vitamins, magnesium, calcium, Vit D and Zinc for some time, so there should (theoretically) not be a problem with his blood pH.

He has had 02 on demand for some time. My understanding this has the effective ability to deliver 02 up to 160 lpm. ???? Anyway, hyperventilating, crunching have still not enabled him to abort an attack. So far, it just increases the level of the attack.

Is he just not human?

Of course, because of the many asymptomatic issues he's had, at this point I'm not convinced he actually has clusters. Just something that, on the outside, looks a lot like them.

Any thoughts or recommendations on other methods of using the 02 - or other supplements, perhaps, that may affect his body's ability to manage the 02/C02 exchange better - or even just differently?

Thanks in advance if anyone has any suggestions.

Happy Thanksgiving.

Laurie

I agree with Marc. Like most other things, to each his/her own. Marc needs to hyperventilate, Helen has success w/15 lpm, I have success w/7-8 lpm.
I just have a problem with stating absolutes. That's what got me at odds with the Busters in the very beginning.

At least I do it right..... ;)

but do you do it often?

Bob P wrote on Nov 29^th, 2009 at 7:41am:

but do you do it often?

Depends on what we're talk'n about - answer would have to be:

- Not as often as I used to be able to
- Way too often
- Only as needed

Marc

Someone suggested looking into blood diseases, one specifically mentioned is haemochromatosis. This is a disease where there is too much iron in the blood, and the oxygen binds to the iron, not the hemoglobin (if I understand correctly). We'll check with Doc when we're there next week.

I'd like to say that I find Batch's post on CO2 levels interesting as i seam to have most of my full on attacks when I'm at work and rarely at the week end .
I guess this is the link between attacks and exorcise

Garys_Girl wrote on Nov 26^th, 2009 at 2:36pm:

Batch/Marc/Anyone with any thoughts....

Gary continues to not be able to abort attacks with 02.

when gary uses o2 does he inhale and exhale all the way in and all the way out?

Hmmm… I was wondering what kind of reaction the reliability statement would fetch…

Before I respond to some of the comments, let me start by saying I’ve spent the majority of 24 years Naval service flying fighter aircraft on and off aircraft carriers for over 3000 hours flight time. All of that flight time was spent breathing 100% oxygen from takeoff to touch down on every flight with most missions over 2 hours in duration. During that time, I also attended annual training in aviation physiology and oxygen breathing systems.

I’m still here at 65 breathing 100% oxygen for my cluster headaches at flow rates that support hyperventilation. I've done this for the last 4 years and I still pass my annual physicals…

I’ve also spent the last three years studying respiratory physiology texts and hundreds of studies involving hyperoxia, respiratory alkalosis, and pH as they relate to cluster headache abortive mechanisms and the pathophysiology of the cluster headache.

What I’ve learned so far is there’s so much more I don’t know about this topic. Accordingly, I’ll be the first to tell you I don’t have all the answers. I do know that the practice of treating the acute cluster headache by hyperventilating with 100% oxygen is gaining support with cluster headache sufferers and a growing number of neurologists experienced in treating our disorder.

Now for some answers to comments on my original post… This post covers a lot about oxygen therapy and gets a bit long so get comfortable...

Absolutes??? Hardly...

After more than 14 years with cluster headaches and the last four as a chronic, I know better than that.

Bob, at your age I thought you'd at least remember the ‘60s era Western Airlines TV ad that had a bird sitting on top of a Boeing 707 resting against the tail saying, "Western Airlines… The only way to fly."

I guess this comes from me being old as dirt and using colloquialisms from days long past...

Most of the youngsters today probably never experienced having more folks on a telephone "party line" than "Carter's Little Liver Pills" where you had to count the number of rings to know if the call was for you... or treating a headache with Speedy's little Alkaseltzer song, "Plop Plop Fizz Fizz, Oh what a relief it is..."

Today it's likely the pothole saying to the car, "Your tire's all flat and junk... Did I do that?"

For the rest of you... If you've caught my drift... There are a lot of ways to fly... (different flow rates to abort your CH attacks)... IMHO and based on the results from the informal pilot study, if you want the most effective flow rates that give you the greatest efficacy and aborts in the shortest amount of time... ask for a regulator that's capable of at least 25 liters/minute and higher or spend the extra money and buy a demand valve... both support hyperventilation.

Ultimately, the best and most compelling information on effective oxygen flow rates comes from those cluster headache sufferers experienced in the use of this method of oxygen therapy who post here on CH.com. They report that when used correctly and early, the efficacy, in terms of success rate is very high and they abort their cluster headache attacks in much less time than the 7 minute figure I use…

As I indicated in the earlier post, “we’re all wired differently” with respect to the efficacy of medications for our disorder… I think I’m fairly safe with that statement…

I also felt safe in saying there are some who can achieve aborts at oxygen flow rates below 25 liters/minute. A flow rate of 15 liters/minute is reasonable for some folks in this category and I’m sure there are others who can achieve aborts at even lower flow rates, but I’ll caveat that by saying “only for attacks at the lower pain levels.”

Too many of us have unfortunately discovered that aborts with these lower flow rates were not possible at the higher pain levels ≥ Kip-7, or the time it took to achieve the abort was painfully long, > 25 minutes or much longer.

My question was why? I also wanted answers to questions, “Why are flow rates that support hyperventilation more effective?” and “Why are some folks are able to abort their attacks effectively at lower flow rates than 25 or 15 liters/minute?”

So let’s talk about hyperventilation for some possible answers… In simple terms, hyperventilation means ventilating the lungs with more air or 100% oxygen than normal…

That begs the questions, “What’s Normal?” and “How Much More?” The answer to the first question is… “That depends.” It basically depends on your weight and the level of physical activity (metabolic rate)…

The second question, “How Much More?” can best be answered by saying as little as 10% to as much as a 100% more lung ventilation than normal depending metabolic rates and how fast you want to abort the pain of your cluster headache attack.

If we’re in a vegetative state, flaked out on the sofa watching TV or asleep, respiratory physiologists will tell us the human body needs roughly 7.5 cc of air per kilogram of weight per minute. If you’re in my shape, (round is a perfectly good geometrical shape), and weigh in at 200 lbs (90 kg), that works out to a respiration minute-volume of lung ventilation equal to 6.75 minute liters inhaled every minute just to supply our bodies with the needed oxygen to sustain life and remove the CO2 produced at that level of metabolism.

If you weigh 150 lbs (68 kg) you need a respiration minute-volume of 5.1 liters

If you weigh 120 lbs (54.5 kg) you need a respiration minute-volume of 4.1 liters

If you weigh more than, less than, or in between these weights… interpolate.

That means under the above conditions and weight we need a minute-volume of lung ventilation somewhere between 5 and 14 liters minutes in order to hyperventilate during oxygen therapy, (an oxygen flow rate of 5 to 14 liters/minute…) and that’s if we’re in a vegetative state, asleep, or sitting motionless... So there’s one possible set of answers why lower oxygen flow rates can be effective in aborting cluster headaches for some folks.

How many of you are able to sit motionless while trying to abort a cluster headache attack with oxygen therapy?

Now here’s the eye-opener… The folks at the S.E.A. Group, an organization that determines breathing requirements for self contained breathing systems used by first responders like fire fighters and rescue workers wearing chemical, biological, and nuclear protection have come up with some answers. They published a report titled “Peak Inhalation Air Flow & Minute Volume during a Controlled Test Performed on an Ergometer.” (An ergometer is a device like a bicycle or rowing machine that’s equipped with instruments to accurately measure the work performed.)

S.E.A. researchers used their Subject Test Laboratories to measured respiration parameters with an instrumented full face mask respirator and at the same time, the work rate in Watts measured with a ergometer. Both devices were connected to a computer to capture the data. Ten test subjects (8 male and 2 female) participated in the study. They had an average age of 34 (min 17, max 59) and weight of 77 kg (min 61, max 96). Each test subject performed the same test sequence of increasing work loads and repeated this sequence 63 times.

The researchers found a work rate of 50 Watts required an average of 22.2 minute liters of lung ventilation. Again, that’s the volume of lung ventilation inhaled every minute just to supply the body with oxygen to sustain life and remove the CO2 produced at that level of metabolism.…

I can hear the wheels turning… “What is a work rate of 50 Watts?” Here’s the answer:

Sitting at ease: Writing, typing on your computer, drawing, sewing, or playing cards.
Standing: Fixing dinner, working with small objects at a workbench.
Walking slowly: Speed up to 3.5 km/h (2.2 mph – 3.2 ft/sec).

In simple terms, 50 Watts is about the same work rate most of us develop during an average cluster headache attack that has us agitated and moving around.

So… If you’re doing any of the above activities… or having a typical cluster headache attack and that requires a minute volume is 22.2 minute liters under normal conditions, you’ll need a minute volume of 24.4 up to 44.4 minute liters of lung ventilation to hyperventilate… and that works out to an oxygen flow rate of 25 to 45 liters/minute.

If you're working hard, like chopping wood with an axe; shoveling or digging; climbing stairs, ramp or ladder; walking quickly with small steps, running, or walking rapidly at a speed greater than 7 km/h or 4.4 mph (6.5 ft/sec), you're at a work rate 150 Watts and that requires a minute volume of lung ventilation over 50 minute liters.

Again, that’s the volume of lung ventilation inhaled every minute just to supply the body with oxygen to sustain life and remove the CO2 produced at that level of metabolism.…

The data we collected in our pilot study shows a clear linear relationship between abort times and pain levels for oxygen flow rates below 25 liters/minute and above… The higher the pain level during oxygen therapy, the longer the abort times. This was consistent for all flow rates.

What literally jumped out of the pilot study data, was a marked difference in abort times between oxygen flow rates below and above 25 liters/minute at the same pain level… For example at a peak pain level of Kip-7 during the oxygen therapy, the average abort time using flow rates that support hyperventilation was 8 minutes while the average abort time was nearly 4 times longer at 31 minutes for the same pain level when using a flow rate of 15 liters/minute.

This difference in abort times was consistent at all pain levels logged between Kip-3 and Kip-9. In short, if the oxygen flow rate is high enough to support hyperventilation and it can be sustained long enough to reach respiratory alkalosis, the abort times will be shorter by nearly a factor of 4.

Bob hit pay dirt with his comment about pH and Michael Crichton’s novel, The Andromeda Strain. Hemoglobin chemistry controls the essential processes that transport of oxygen from the lungs to the body and CO2 from the body to the lungs. It’s also the same process that makes this method of oxygen much more effective and faster in aborting our cluster headaches than the lower flow rates typically prescribed.

When blood pH is high (more alkaline) as it passes through the lungs, hemoglobin has a greater affinity for oxygen so it uploads oxygen. A high pH also causes hemoglobin to offload CO2 although most of the CO2 is carried by the blood serum. When blood reaches the body’s tissues and muscles where the pH is low (more acidic) due to the processes involved with normal metabolism, hemoglobin offloads oxygen. The lower pH also increases hemoglobin’s affinity for CO2 so it uploads CO2.

Respiratory Physiology texts clearly state it’s primarily CO2 levels not a lack of oxygen that actually controls the urge to breathe. When CO2 levels in the blood climb above normal during physical activity, chemoreceptors located in the aorta, carotid arteries, and medulla sense this increase and signal the breathing control center located in the medulla to increase the respiration rate in order to bring the CO2 levels back down to normal.

There are also a number of complex biochemical and hormonal processes controlled by the sympathetic nervous system and the lungs that regulate the vasoactivity of the body’s vascular system. Changes in CO2 and pH levels shift these processes in one direction or the other resulting in vasoconstriction or vasodilation.

If blood CO2 levels are above normal, these processes signal the vascular system to dilate allowing a greater transport of CO2 to the lungs. If blood CO2 levels are below normal, these processes signal the vascular system to constrict. This slows the transport of CO2 to the lungs and allows it to build back up to normal levels.

The majority of the CO2 generated by metabolism dissolves in the blood serum as it passes through the tissues, the rest attaches to hemoglobin. Some of this CO2 disassociates into carbonic acid as shown in the chemical equation below:

CO2 + H2O ⇌ H2CO3 ⇌ HCO3- + H+

The above reaction takes place in the tissues very rapidly in the presence of an enzyme called carbonic anhydrase where CO2 concentrations are the highest. This shifts the chemical reaction to the right. The same reaction takes place in the lungs only the direction of the chemical reaction shifts to the left releasing CO2 through the alveoli as a gas into the exhaled breath. This same reaction is the primary mechanism the body uses to maintain the blood acid-base balance.

Many of us have experience just how effective carbonic anhydrase can be in releasing CO2 from a liquid only we never new why… Have you ever awaken from sleep or worked hard on a hot day then taken a gulp of your favorite carbonated beverage only to have it flash into a mouthful of foam?

It turns out that carbonic anhydrase is present in saliva. During sleep or physical activity where mouth breathing is common, the carbonic anhydrase in our saliva tends to concentrate in the mouth. When it comes in contact with a carbonated beverage, it liberates the dissolved CO2 as a gas.

Higher blood CO2 levels means higher blood acid levels and that results in a lower pH measurement. The body’s vascular system reacts to high CO2 and acid levels by dilating in order to increase blood flow to the lungs allowing CO2 levels to drop back to normal. This also brings the acid - base balance back to a neutral pH of 7.4 (7.35-7.45). This happens whether we’re breathing air or 100% oxygen.

As discussed earlier, a higher than normal blood CO2 level generates more carbonic acid and a lower pH. This results in vasodilation that can make the cluster headache triggering mechanism more effective. We see the results of lower pH levels as an increase in the frequency, intensity, and duration of our cluster headache attacks.

By intentionally hyperventilating long enough on 100% oxygen we pump CO2 from the lungs faster that our body generates it. By continuing to hyperventilate, we pump out enough CO2 to push the bloodstream into respiratory alkalosis.

If we boil it all down, hyperventilating on 100% oxygen enables 4 important processes and their results that combine to abort our cluster headache attacks more effectively and more rapidly:

1. It increases the oxygen content of the blood
(hyperoxia) – A vasoconstrictor
2. It decreases the CO2 content of the blood (hypocapnia)
– A vasoconstrictor
3. Hypocapnia results in respiratory alkalosis that elevates
pH – A vasoconstrictor
4. Elevated pH enables blood hemoglobin to carry more
oxygen – Increased abortive effect

Now here is how we can run into trouble when trying to abort our cluster headache attacks with oxygen at flow rates that don’t support hyperventilation. It only takes an oxygen flow rate of 7 to 9 liters/minute to achieve hyperoxia, the first of the four processes above.

If we use a non-rebreathing mask that limits lung ventilation to the flow rate set on the regulator, and that oxygen flow rate supports a respiration rate that’s less than the body needs to regulate CO2 levels due to the physical activity associated with our cluster headache attack, we have inadequate lung ventilation and are essentially hypoventilating. If this continues, CO2 levels will build until we develop respiratory acidosis.

Now the problem… Even though an oxygen flow rate of 7 to 9 liters/minute may provide adequate oxygenation, the remaining three processes above that worked so well for us when we were hyperventilating are reversed. They start working against us to prevent a successful abort if we don’t have sufficient lung ventilation to remove excess CO2.

2. It increases CO2 content of the blood (hypercapnia)
– A vasodilator
3. Hypercapnia results in respiratory acidosis that lowers
pH – A vasodilator
4. Low pH causes blood hemoglobin to carry less oxygen –
Decreased abortive effect

Symptoms of this condition are easy to spot and many of us have encountered them when trying to abort a painful cluster headache attack at the higher Kip-levels using a disposable non-rebreather oxygen mask and too low an oxygen flow rate. The symptoms are:

• A feeling of restricted respiration (can’t get enough
oxygen or deep enough breath)
• Anxiety
• Panic Attacks

When these symptoms are present, an abort with oxygen therapy can be very difficult if not impossible… Most of us who’ve encountered these symptoms have made one of the following decisions: given up on oxygen therapy completely, kept using oxygen therapy, but frequently resorted to a bailout abortive like imitrex, or dialed up a higher oxygen flow rate.

The following graphic of vasoactivity summarizes the relative impact of oxygen (O2), pH, and CO2 levels with respect to their abortive effects on cluster headache attacks.

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to

END PRINTPAGE

This graphic illustrates the relative influence oxygen, pH, and CO2 levels have on vasoactivity and the effectiveness of oxygen therapy. I’ve reviewed a number of clinical studies that conclude these are essentially independent variables, and that pH and CO2 have a greater effect on vasoactivity than oxygen.

This helps explain how the beneficial effects of hyperoxia can be overridden by higher than normal CO2 levels and a low pH. It also helps explain the pilot study results where cluster headache attacks at higher pain levels took longer to abort. The correlation coefficient between the average abort times for attacks at Kip-levels 3 through 9 is 0.94. This indicates a high level of correlation with a near linear and very predictable relationship between average abort times and Kip-levels.

So far, I’ve covered how this method of oxygen therapy works and why it’s so much more effective in terms of success rate and with much shorter abort times when compared to oxygen therapy at flow rates that don’t support hyperventilation.

As this discussion covered oxygen therapy under “normal” conditions, that begs the question, "What happens when things aren't normal or when there are other conditions that can impact the effectiveness of oxygen therapy?"

I’ll save that discussion for another post… This one is long enough… Hope it helped explain why oxygen therapy at flow rates that support hyperventilation is more effective than the lower flow rates prescribed today… Safe too!!!

Take care,

V/R, Batch

I've just started O2 therapy again, and it seems to work. I'm able to abort an episode in approx. 10 mins (plus 5 for good measure). However, it seems that my CHs come back bigger, badder, stronger, faster approx. 2 hours later.

has anyone else experienced this?

Batch, I always appreciate the detailed explanation. Thank you.

-johnny- wrote on Dec 6^th, 2009 at 8:15pm:

Garys_Girl wrote on Nov 26^th, 2009 at 2:36pm:

Batch/Marc/Anyone with any thoughts....

Gary continues to not be able to abort attacks with 02.

when gary uses o2 does he inhale and exhale all the way in and all the way out?

To our knowledge, yes. He's tried numerous different breathing methods at this point. And different breathing methods combined with different positions: lying flat on his back, standing up, sitting upright, breathing very deeply in and out... breathing deeply in and out with an "extra" push on the exhale (like a double exhale for each inhale).

Then I read up on blood pH, and he tried breathing in and out very rapidly for 5 or 6 breaths, then giving an extra long exhale and squishing forward to like scrunch his abdomen up forcing air out of his lungs and repeating this..

All of this is on a demand valve now.

His GP was of the opinion there was no reason to look into blood diseases as he's had so much blood work done that something in his hematocrit would have pointed to further studies. We're at the neuro at Montefiore again next week though, so we'll ask him too.

The people at LifeGas mentioned that Dr. Rozen is based in Philly now, so we'll also look into the possibility of going directly to the source, so to speak.

From: Pathophysiology of trigeminal autonomic cephalalgias, The Lancet Neurology, Volume 8, Issue 8, August 2009:

Quote:

Vasodilation of intracranial arteries ipsilateral to the pain is well documented during CH attacks and has been proposed as the pain source in CH.
However, intracranial vasodilation is not speciﬁc to CH as this vasodilation is also present in experimental forehead pain.
Moreover, attacks of CH pain can occur even if vasodilation is prevented by trigeminal sectioning.

From: Oxygen Inhibits Neuronal Activation in the Trigeminocervical Complex After Stimulation of Trigeminal Autonomic Reflex, But Not During Direct Dural Activation of Trigeminal Afferents, S Akerman, PR Holland, MP Lasalandra & PJ Goadsby. Headache (2009) 49: 1131-1143

Quote:

Results.-Meningeal vasodilation and neuronal firing in the trigeminocervical complex (TCC), in response to dural electrical stimulation, was unaffected by treatment with 100% oxygen. Stimulation of the SuS via the facial nerve caused only marginal changes in dural blood vessel diameter, but did result in evoked firing in the TCC. Two populations of neurons were characterized, those responsive to 100% oxygen treatment, with a maximal inhibition of 33%, 20 minutes after the start of oxygen treatment (t15 = 4.4, P < .0001). A second population of neurons were not inhibited by oxygen and tended to have shorter latency. Oxygen also inhibited evoked blood flow changes in the lacrimal sac/duct caused by SuS stimulation.head_1501 1131..1143

Sounds like the vasoconstricting effect of O2 is (mostly ?) irrelevant in the treatment of clusters and that vasolidation isn't the problem either.

I don't know much, but I know that O2 at a slower flow rate used to work ok for me but this last bout of clusters lasted for 16 weeks with one ER visit and lots of painful days and nights.

I am fully planning on getting a very high flow regulator for next year and hopefully get a chance to go see Dr. Rozen if at all possible.

Thank you Batch for doing so much research.

Blessings!
karen

One more trick with the O2 is to take a deep breath of O2 and hold it as long as you can.

I sure hope Gary finds some help, I know it's not easy for either of you. Often I think, what would I do in his situation?

Prayers to you, Don

You've educated yourself well Batch! And. yes, I do remember the bird on the plane and party lines.
After my last cluster, I did buy a 25 lpm regulator and optimask so I will experiment with your process (if I ever get hit again).

Bob P wrote on Dec 11^th, 2009 at 7:54am:

"IF" being the key word here, Bob.

Here's to hoping you maintain a brand new unused regulator.

Marc

I have found that this works best for me most of the time.
1. Get heart and respiration up with vigorous exercise
2. Empty my lungs as much as possible
3. Fill lungs with pure 02
4. Hold in the 02 for 15 ~30 seconds
Repeat steps 2 - 4 until you feel the Beast subside or you are convinced it isn't going to work. If it doesn't seem to be working go back to step 1 and exercise harder then try the 02 again.
Nothing works the same for everyone, sometimes things that have worked in the past suddenly stop working. Keep trying different methods till you find what works for you.

Batch wrote on Dec 7^th, 2009 at 10:39am:

As this discussion covered oxygen therapy under “normal” conditions, that begs the question, "What happens when things aren't normal or when there are other conditions that can impact the effectiveness of oxygen therapy?"

I’ll save that discussion for another post… This one is long enough… Hope it helped explain why oxygen therapy at flow rates that support hyperventilation is more effective than the lower flow rates prescribed today… Safe too!!!

Take care,

V/R, Batch

Batch, did you ever write the follow-up: what happens when things aren't normal?

If so, I'll just go search for it.

You don't know how much I appreciate the hard work you're doing, the support you've provided, and the REALLY detailed information. "Thank you" hardly seems to cover it.

We still haven't gotten 02 therapy to work, but he's ready to try yet again. (He gives it a try every month or so. The main problem is that the failed attempts result in even worse rebounds immediately, so it's hard for him to just keep trying and trying).

I am becoming more and more convinced that Gary is, in fact, an alien.

...I will add... that with the fevers he gets, I do think that his hypothalamus is truly just "broken," and perhaps there is nothing that will help.

Laurie

New CH.com Forum
http://www.clusterheadaches.com/cgi-bin/yabb2/YaBB.pl Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Inefficient O2 usage http://www.clusterheadaches.com/cgi-bin/yabb2/YaBB.pl?num=1258789122 Message started by slacker032 on Nov 21^st, 2009 at 2:38am