Inhaled Oxygen and Cluster Headache Sufferers in the United States: Use, Efficacy and Economics

Results From the United States Cluster Headache Survey

Todd D. Rozen, MD, FAAN; Royce S. Fishman, BA


Headache. 2011;51(2):191-200. 

In This Article


Several key conclusions can be drawn from our survey:

  1. Oxygen is underutilized for CH patients living in the United States.

  2. Prescribed oxygen flow rates may be too low for efficacy and truly high flow oxygen of 12 L/minute or higher appears to be required for efficacy in many patients.

  3. Oxygen in its current recommended prescribed form of 100% oxygen via a non-rebreather face mask delivered at 7–12 L/minute is not meeting the needs of many CH patients. This is reflected in the low percentage of CH patients using oxygen at all or solely as acute treatment. The potential reasons for this are numerous as based on the survey results. Oxygen is slow to onset compared with injectable sumatriptan. Oxygen, despite its much lower cost than injectable sumatriptan, can still be expensive and is difficult to obtain with sufferers often being left to find their own sources of oxygen.

  4. Oxygen efficacy does not appear to vary by the age of the patient, gender, the number of CH attacks per day, and smoking history. Episodic CH responds better and faster to inhaled oxygen than chronic CH.

  5. Physicians need to be better educated on the use of inhaled oxygen for CH. There appears to be a true lack of understanding about oxygen's efficacy and what is required to prescribe oxygen. More placebo-controlled studies looking at the efficacy of inhaled oxygen would certainly enhance physician acceptance of this treatment strategy.

  6. Headache specialists and neurologists need to know that patients are pushing oxygen flow rates regardless of what is on their prescription and they are combining abortives to get better efficacy.

  7. Oxygen plus a triptan or DHE may be more efficacious and faster at aborting a CH than a triptan or DHE alone. Thus, if a triptan is not very effective for a CH patient combining treatments with oxygen may make treatment response improved.

  8. Medical insurance carriers need to recognize that inhaled oxygen is an effective treatment for CH and they need to make the process to obtain oxygen easier and more streamlined. Importantly, 12% of CH patients in the United States are getting welder grade oxygen because of the costs of medical grade oxygen and this form of oxygen could be potentially dangerous to the individual user.


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