Why is it we cannot seem to get the medical community to look beyond "100% oxygen 6-12 L/min"?  At 6-12 L/min I'm sucking the bag flat and having to take the mask off because I can't get enough to breathe.  At 15 L/min I gave up because I didn't get enough relief to make it worth the 5-10 minutes difference of going without it.  I wish they would do a real study with high flow oxygen at least15 L/min, but preferably at 25 L/min or greater to where it would do some good.  The difference between 15-20 mins sucking for breath at 15 L/min and 5 mins at 25-30 L/min is vast.

It seems most of these studies keep rehashing what others have already established in prior studies and don't break any new ground.

Test showing relief in 15 mins is showing something of value, but many of us have attacks that end in about 30 mins anyway, so a 30 minute "cessation" is not a great accomplishment.  Much like suffering with a cold for 14 days or taking the medicine and getting over it in only 2 weeks.

Bob, this in not directed at you!  I really appreciate all you do to bring these things to our attention, and I've learned quite a bit from you.  It is the medical community that just keeps rehashing the same stuff over and over to justify monies raised for "research" that don't get into anything new that gets my goat.

Rant over.   

Jerry

Thanks for the reply Bob.  I'll try to be patient.  I really appreciate your posting these reports as they come out, and I realize the complexity of some of the reports and studies.  I also recognize the limited supply of subjects to be studied.  I just feel that sometimes they keep trying to reinvent the wheel and keep duplicating other's work.  I know if it isn't duplicatable it isn't science, but it seems we just keep seeing the same thing.

I know, I'm hard to please.

Jerry

Jerrry: I neglected to make an important comment about the nature of the scientific method: every time  research duplicates the findings of other research it's a plus--the evidence for the "truth" is stronger. NO scientific type accepts one or two findings, even if exactly the same outcome, as definitive or final.

We have regularly seen cases of a medicine, having gone thru years of research and having been approved for use (all the research was in substantial agreement) being withdrawn from use because some new research outcome has come out of left field (which negates the earlier studies). Science is not easy even if, at its best, it's powerful and a real benefit to us.

Here's one of the studies (the easiest to cut/paste) that I found on intranasal civamide - mind you, it's from 2002.  I did also find a summary article from 2009 saying that intranasal civamide wasn't any use in prevention (couldn't copy/paste it), but that's medical research for you...
On the other hand, if you're out of other options, it may be worth trying...


July 9, 2002 — Intranasal civamide, a synthetic isomer of capsaicin, may be modestly effective in preventing episodic cluster headache, according to results of a multicenter, double-blind, randomized trial reported in the June issue of the Archives of Neurology.

"When civamide is applied intranasally to the mucosa, the release of neurotransmitters by the trigeminal plexus centrally to meningeal and dural blood vessels should be decreased," write Joel R. Saper, MD, from the Michigan Headache Pain and Neurological Institute in Ann Arbor, and colleagues. "This would then result in less vasodilation, plasma extravasation, and histamine/serotonin release, with a potential for the amelioration of neurogenic inflammation and cluster headache pain."

This study evaluated 28 subjects at 14 headache/neurology centers in the United States. Over a seven-day treatment period, 18 subjects received 100 ÌL of 0.025% civamide (25 Ìg ; total daily dose, 50 Ìg ) and 10 received 100 ÌL of the vehicle to each nostril via dropper once daily. Observation continued over a 20-day posttreatment period.

Decrease in the number of headaches from baseline to posttreatment during days 1 through 7 was -55.5% in the civamide group and -25.9% in control patients ( P=.03). There was a trend suggesting continued decrease in the number of headaches with civamide during the 20-day follow-up period ( P=.05).

Both groups were similar in cluster headache pain intensity, number of severe headaches, and associated symptoms. The most common adverse events included nasal burning in 14 of 18 civamide-treated subjects and in 1 of 10 vehicle-treated subjects ( P=.001) and lacrimation, seen in nine of 18 civamide-treated subjects and in none of the controls ( P=.01).

"Intranasal civamide solution at a dose of 50 Ìg may be modestly effective in the preventive treatment of episodic cluster headache," the authors write. "There are no medications for the prevention of cluster headaches currently approved by the Food and Drug Administration, and subcutaneous sumatriptan is the only approved medication for abortive therapy of individual cluster headache attacks. Since cluster headaches are among the most severe headaches known and result in significant disability during active cluster periods, any therapy that can reduce their frequency would be valuable."

The authors suggest that the small number of subjects may have contributed to the lack of significance of the secondary efficacy parameters. To decrease the transient nasal burning, rhinorrhea, and lacrimation, they propose several modifications in civamide administration. Future studies will be larger, prospective rather than retrospective, and will have a longer posttreatment period.

"This study offers early support for the possible value of intranasal civamide as a safe and effective preventive treatment for episodic cluster headache," they conclude.

Winston Laboratories Inc., Vernon Hills, Illinois, partially funded this study.

Arch Neurol. 2002;59:990-994