High Flow Oxygen

High flow oxygen was proven to relieve cluster headache attacks within 15 minutes for nearly 80% of attacks with no serious side effects in a controlled clinical study (see the JAMA High-flow Oxygen Study). In fact, high flow oxygen is considered to be the safest method of treating acute cluster headache attacks. The approach is to use 100% pure oxygen at a flow rate of 12-15 lpm, sometimes higher, through a non-rebreather mask for approximately 15 minutes or until the attack is stopped. Although that sounds pretty straightforward, learning how to use high flow oxygen for quick relief takes some know how and practice. On this page, we describe how to get it, how to use it, and how to be safe with oxygen in the home.

For whatever reason, many doctors who are not very familiar with cluster headache treatment are reluctant to prescribe high flow oxygen for home use. It is, in fact, much safer and much less expensive than other medical options and has proven efficacy. If your doctor is reluctant or dismissive of high flow oxygen for your treatment and you have been diagnosed with cluster headaches, do not take “No” for an answer. Providing the doctor with a printout of the JAMA High-flow Oxygen Study and respectfully pressing for a rationale regarding denying the appropriate treatment will usually suffice. As in all things with a rare disease like Cluster Headaches, it’s important to build some rapport with the doctor and assume that they are working in your best interest, but may not be very familiar with this disease. If you find too much resistance, consider going to another doctor, preferably a headache specialist neurologist. If the doctor is reluctant to prescribe oxygen, he or she will probably be reluctant to provide you with adequate preventative medication as well.

Oxygen Tips & Tricks

Aborting a cluster attack with high-flow oxygen is not entirely intuitive and it takes some practice to get good at it. By all means, if it is your first time using your home oxygen setup, give it a trial run BEFORE you are having an attack. The oxygen won’t hurt you. Success versus failure in aborting an attack usually boils down to a few simple things to keep in mind:

  • The Earlier the Better
    It is important to get on the oxygen at the first sign of an attack. In some cases, it is possible to head it off completely. If you wait too long, it is not likely you will successfully abort the attack.
  • Pay Close Attention to the Reserve Bag
    Wait a few seconds for the reserve bag to fill completely before inhaling the oxygen. The reserve bag should be your gauge for determining if you are getting enough oxygen. If the flow rate is set too low or if the tank is running low, your reserve bad may not completely refill between breaths. The optimal situation is that you never completely flatten your reserve bag and that it is nearly fully inflated before inhaling. If your reserve bag remains inflated while inhaling, you may not be inhaling deeply enough. Adapt your oxygen flow rate based on your reserve bag. If it goes flat during use, increase your oxygen flow. If you are maxed out on you regulator’s flow rate, consider getting a higher flow regulator or a demand valve. If your reserve bag is never close to empty, you may be wasting oxygen. Your ability to consume oxygen will vary at different times, so always use your reserve bag as your guide.
  • Take Long Deep Breaths
    The idea is to consume as much pure oxygen as you can. Deep breaths allow the oxygen to fully transfer in the lungs. Rapid, short-succession breathing may make you dizzy and will not accomplish the goal of aborting the attack. Breath deep repeatedly, near the point of hyperventilation, for best results. The best position for aborting an attack is sitting or standing upright. Normal breathing or shallow breathing while lying down generally will not abort a cluster attack. This is an active process that is physically demanding.
  • Stay on the Oxygen
    Remain on the oxygen for at least 3-5 minutes past relief of the attack. Occasionally an attack can recur after stopping the oxygen. Get right back on the oxygen, taking deep breaths until the attack has ceased.
    Keep the oxygen mask tight against the face while inhaling. The concept is to inhale pure oxygen. Any leaks on the mask edge will allow in room air which will dilute the oxygen ratio. It is not important to keep the mask tight during exhalation, but be cautious not to spill oxygen unnecessarily. A cannula or nose apparatus will not work. You will need a non-rebreather mask for good results.

If at first you don’t succeed, try, try again. It is worth getting this right.

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