Inhaled oxygen in cluster headache: Results of the Clusterbusters Medication Use Survey

Objective: The Clusterbusters Medication Use Survey characterized the use and efficacy of inhaled oxygen in cluster headache patients in order to identify the various factors that optimize therapy.

Background: Inhaled oxygen is one of the mainstay abortive medications in cluster headache, though it is not easily obtained by all. Physicians who prescribe oxygen for cluster headache may not be aware of the most effective delivery systems or flow rates. Furthermore, home oxygen for cluster headache is not reimbursed by Medicare.

Design/Methods: Subjects were recruited from cluster headache websites and headache clinics. The final analysis included responses from 496 participants. The survey was modeled after previously published surveys and was available online. Most responses were chosen from a list, though others were free-texted.

Results: Inhaled oxygen was among the most effective abortive medications in cluster headache and remained equally effective between younger and older age groups. This held across gender, headache type, smoking status, and alcohol status subgroups. Oxygen flow rates above 10 L/min were more effective than lower flow rates. This also held across subgroups or showed a similar trend. The non-rebreather (NRB) mask was the most commonly used mask, though other types had similar efficacy. Triptan injection was also an effective abortive medication, though most comments about unwanted medication side effects were with regards to triptans.

Conclusions: Inhaled oxygen retains its efficacy for aborting cluster attacks with advancing age and has a more favorable side effect profile than tripans. The NRB mask was the most commonly used mask type and oxygen flow rates above 10 L/min conferred greater efficacy. The findings from this survey further demonstrate the safety and efficacy of oxygen in the treatment of cluster headache and support its use in all patients.