Hey Jay,

That's a heck of a way to get an Rx for oxygen therapy, but at this point, there's no sense in arguing with success.  Good on you!

It also appears you've mastered the art of oxygen therapy at a flow rate of 15 liters/minute.  Again...  Well done!

What you might want to think about now is looking for a good 0 to 25 liter/minute oxygen regulator or better yet, a 0 to 60 liter/minute oxygen regulator. 

I realize these might sound like high flow rates… and compared to 7 to 9 liters/minute or even 15 liters/minute...  they are…  but for good reasons and they're very safe...  More so I might add, than other cluster headache medications as oxygen inhalation therapy has virtually no lasting side effects.

For starters, oxygen flow rates of 25 liters/minute and above support hyperventilation.  Flow rates this high will bring the time to abort your cluster headaches down from 20 minutes to an average of 7 minutes.   We've data on over 600 aborts with oxygen therapy, 366 of these aborts were made at flow rates that support hyperventilation that confirm these figures.

More about the good reasons...  It turns out that when arterial carbon dioxide (CO2) builds above normal levels, it acts as a very powerful vasodilator that can actually overpower the beneficial effects of oxygen therapy as a vasoconstrictor in aborting your cluster headache attacks.  This makes an abort when using lower oxygen flow rates difficult and lengthy if not impossible.

When we hyperventilate with 100% oxygen, we cast off CO2 in exhaled breath faster than our bodies can generate it through normal metabolism and physical activity.  This will push our respiratory and circulatory systems into a temporary condition called respiratory alkalosis (arterial pH more alkaline than acid).  You'll know you've reached this condition when you start feeling the symptoms of paresthesia. 

These symptoms include a slight tingling or prickling sensation of the fingertips, lips, or back of the neck.  We may also experience a slight feeling of dizziness.  Again, as strange as this may sound, any of these symptoms of paresthesia are a good sign we're hyperventilating effectively and this will help bring about an abort of our cluster headache as fast as possible.

The symptoms of paresthesia also indicate we've cast off enough CO2 to reduce the acid content of the blood stream and elevate its pH.  And, as an elevated pH causes blood hemoglobin to have a greater affinity for oxygen, blood cells super oxygenate delivering more oxygen to the brain to further increase the vasoconstriction needed for fast aborts.

A flow rate of 40 to 50 liters/minute of lung ventilation is really quite common.  Stated differently, the volume of air or oxygen inhaled into the lungs in one minute (the Minute-Volume) is a lot higher than most folks think even with only a moderate level of physical activity. 

For example, if we were to climb a couple flights of stairs at a fast pace, walk or dance rapidly, or lift heavy weights, we would build up enough CO2 and lactic acid in the blood stream to stimulate a lung ventilation of over 50 Minute Liters just to cast off the excess CO2 generated as a result of the physical activity.

I have over 3000 hours flight time in Navy fighters and all of that flight time was spent breathing 100% oxygen from takeoff to tough down with the average mission lasting over two hours.   I can tell you that when I was flying aerial combat and air-to-air training missions, the physical exertion encountered during high G-force maneuvers had me sucking down oxygen at flow rates well above 45 liters/minute.

Putting this in perspective, during high Kip-level hits, most of us are unable to remain motionless so we do the little dance, munch on the carpet, rock back and forth, or bang on our heads.  Even this level of physical activity can easily generate enough CO2 to stimulate lung ventilation with room air on the order of 25 to 30 Minute Liters.

This is where an oxygen flow rate of 15 liters with a non-rebreathing mask may not sufficient to abort a cluster headache and can put us between a rock and a hard place.  The body is calling for increased lung ventilation at a flow rate of 25 to 30 liters/minute (a minute volume of 25 to 30 Minute Liters), but the regulator and mask will only deliver 15 liters/minute... 

When that happens, the body cannot cast off CO2 fast enough so the level arterial CO2 rises even farther above normal with a net result of increased vasodilation, and no abort...

Sooo... you see... there are some very good reasons for being able to administer oxygen therapy at flow rates of 25 liters/minute and above.

Hope this helps.

Take care,

V/R, Batch