# Cluster headaches and oxygen



## Brandon O (Aug 11, 2013)

Anybody have any experience using O2 to manage a patient with cluster headaches?

Maybe a long shot due to the rarity, I know...

A bit of background: http://www.ncbi.nlm.nih.gov/pubmed/19996400


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## EMT2B (Aug 11, 2013)

No experience, but it sounds like a pretty cool idea.  I get cluster headaches/migraines every so often (thankfully, not very often!) and that sounds like an awesome way to help make them go away!  I'd be interested in follow-up studies.


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## Anonymous (Aug 11, 2013)

Brandon Oto said:


> Anybody have any experience using O2 to manage a patient with cluster headaches?
> 
> Maybe a long shot due to the rarity, I know...
> 
> A bit of background: http://www.ncbi.nlm.nih.gov/pubmed/19996400



I don't have experience with it but have read it is one of the few things that seem to help.


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## CodeBru1984 (Aug 12, 2013)

My partner gets them and he has used O2 in the past to aid in relieving them.


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## TheLocalMedic (Aug 12, 2013)

Ever hear about using psilocybin mushrooms to prevent cluster migraines?  Sounds bizarre but it's supposed to work.  

http://channel.nationalgeographic.com/channel/drugs-inc/videos/magic-mushroom-medicine/


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## Handsome Robb (Aug 12, 2013)

TheLocalMedic said:


> Ever hear about using psilocybin mushrooms to prevent cluster migraines?  Sounds bizarre but it's supposed to work.
> 
> http://channel.nationalgeographic.com/channel/drugs-inc/videos/magic-mushroom-medicine/



I've seen that. It was definitely really interesting.


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## TheLocalMedic (Aug 12, 2013)

I have heard anecdotal reports of oxygen working for cluster migraines if used immediately at onset, but I haven't seen much hard data to support it.


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## Brandon O (Aug 12, 2013)

Let's try and maintain the distinction between migraines and true cluster headaches, which (in my slim understanding) are a distinct entity.

Cluster headaches are far more rare and cause some of the most severe pain known to medicine. They are considered a risk factor for suicide.


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## KellyBracket (Aug 12, 2013)

I've used oxygen in the past on headaches that I had _thought_ might be cluster. But even with years in EMS/EM, I'm no neurologist. 

Now I just hit them all with metoclopramide, go from there.


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## Brandon O (Aug 12, 2013)

KellyBracket said:


> I've used oxygen in the past on headaches that I had _thought_ might be cluster. But even with years in EMS/EM, I'm no neurologist.



So as a non-neurology, knuckle-dragging emergentologist, did it seem to help?


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## KellyBracket (Aug 12, 2013)

As my mentor Doctor Cottle would say, I have no frakking clue. 

The dopamine antagonists seem to work via some common pathway nonsense, so I don't have worry about etiological finery. 10 mg * 2 seems to take care of 90+% of HA.


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## EpiEMS (Aug 12, 2013)

How does high flow O2 help relieve pain of cluster headaches? That is to say, why is it better than placebo?


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## mycrofft (Aug 12, 2013)

Cluster headaches are not new and they aren't *all* DEFCON 4. Used to successfully treat many of them with  chlortrimeton or benadryl. P.O. Trick is to recognize the symptoms and complaints. EDIT: and begin treating early.

We used to give VIstaril and Demerol IM for "migraine headaches"; it's not unlikely the Vistaril was swatting down the cluster headaches (and addressing Demerol's side effects), and the Demerol (when it didn't make people hallucinate or  vomit) covered the rest and made patients not care so much about having a headache.


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## Brandon O (Aug 12, 2013)

EpiEMS said:


> How does high flow O2 help relieve pain of cluster headaches? That is to say, why is it better than placebo?



From what I can glean, the prevailing theory behind cluster headaches seems to be that they involve inappropriate vasodilation which creates mechanical pressure upon the trigeminal nerve. The oxygen is thought to cause vasoconstriction.


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## Anonymous (Aug 12, 2013)

Brandon O said:


> From what I can glean, the prevailing theory behind cluster headaches seems to be that they involve inappropriate vasodilation which creates mechanical pressure upon the trigeminal nerve. The oxygen is thought to cause vasoconstriction.



That is how I understand it. Same reason the Imitrex helps.


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## tod (Aug 13, 2013)

Brandon O said:


> Let's try and maintain the distinction between migraines and true cluster headaches, which (in my slim understanding) are a distinct entity.
> 
> Cluster headaches are far more rare and cause some of the most severe pain known to medicine. They are considered a risk factor for suicide.


all that sounds consistent with my grandfather's diagnosis of cluster headaches.



Anonymous said:


> That is how I understand it. Same reason the Imitrex helps.


i've experienced Imitrex relieving migranes as well.

i'm only in school at the moment, but it seems to me like we use oxygen in almost all situations with a thought that  "why not, it shouldn't hurt". i don't know how common this is in reality, obviously.


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## EpiEMS (Aug 13, 2013)

Brandon O said:


> From what I can glean, the prevailing theory behind cluster headaches seems to be that they involve inappropriate vasodilation which creates mechanical pressure upon the trigeminal nerve. The oxygen is thought to cause vasoconstriction.



Ok, makes sense -- same sort of reasoning behind including caffeine in the AAC tablets. Thanks for a great explanation, makes a lot more sense now!


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## Carlos Danger (Aug 13, 2013)

Brandon O said:


> From what I can glean, the prevailing theory behind cluster headaches seems to be that they involve inappropriate vasodilation which creates *mechanical pressure upon the trigeminal nerve*. The oxygen is thought to cause vasoconstriction.



PA and MD students: 

Quick! without looking it up, name as many branches of the trigeminal nerve as you can.

No, not V1, V2, and V3....._all_ the branches....

I can't remember this stuff to save my life. If anyone knows of any good memory tricks, please let me know.


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## Clipper1 (Aug 13, 2013)

Halothane said:


> PA and MD students:
> 
> Quick! without looking it up, name as many branches of the trigeminal nerve as you can.
> 
> ...



Copy and paste make quotes like that easier.


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## Uclabruin103 (Aug 13, 2013)

TheLocalMedic said:


> Ever hear about using psilocybin mushrooms to prevent cluster migraines?  Sounds bizarre but it's supposed to work.
> 
> http://channel.nationalgeographic.com/channel/drugs-inc/videos/magic-mushroom-medicine/



There was an episode of House where they did that!


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## Carlos Danger (Aug 13, 2013)

Clipper1 said:


> Copy and paste make quotes like that easier.



Huh? What quote?


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## nwhitney (Aug 14, 2013)

I can't remember where I read this and maybe someone else can shed some light on it, I read that giving yourself a "brain freeze" is an effective means to treat a migraine/cluster headache. I think it has something to do with a "resetting" of neurons.


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## chaz90 (Aug 15, 2013)

Just had my first ever patient with cluster headaches and treated with oxygen by NRB at 10 LPM. My partner transported him, but said his headaches were mostly resolved with the O2. The patient also said he had been given a prescription for home O2 in the past to treat his condition but his tank was broken. Cool stuff, and I wouldn't have known about it without this thread.


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## Brandon O (Aug 17, 2013)

Halothane said:


> PA and MD students:
> 
> Quick! without looking it up, name as many branches of the trigeminal nerve as you can.
> 
> ...



Are you looking for the distal sensory branches (after the three main divisions), or the non-GSA components? You can waste many of the best years of your life trying to memorize every little nerve that somebody has put a name to...


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## Handsome Robb (Aug 17, 2013)

chaz90 said:


> Just had my first ever patient with cluster headaches and treated with oxygen by NRB at 10 LPM. My partner transported him, but said his headaches were mostly resolved with the O2. The patient also said he had been given a prescription for home O2 in the past to treat his condition but his tank was broken. Cool stuff, and I wouldn't have known about it without this thread.



The way chart review has been lately I'd get popped for not calling for orders since we don't have a protocol for high flow O2 for cluster headaches.


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## Brandon O (Aug 17, 2013)

Robb said:


> The way chart review has been lately I'd get popped for not calling for orders since we don't have a protocol for high flow O2 for cluster headaches.



I guess on some level I respect a measured approach to oxygen use... but this seems like a bit much.


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## broken stretcher (Aug 20, 2013)

can someone explain what exactly a cluster headache is... what is different from a regular headache?


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## mycrofft (Aug 21, 2013)

broken stretcher said:


> can someone explain what exactly a cluster headache is... what is different from a regular headache?



Probably. Start with Wikipedia.

http://en.wikipedia.org/wiki/Cluster_headache


Or medline

http://www.nlm.nih.gov/medlineplus/ency/article/000786.htm

More pubmed, the pathogenesis:

http://www.ncbi.nlm.nih.gov/pubmed/8081523

Here's oxygen and cluster HA in PubMedhttp://www.ncbi.nlm.nih.gov/pubmed/19996400

"Fifty-seven patients with episodic cluster headache and 19 with chronic cluster headache were available for the analysis. For the primary end point the difference between oxygen, 78% (95% confidence interval, 71%-85% for 150 attacks) and air, 20% (95% confidence interval, 14%-26%; for 148 attacks) was significant (Wald test, chi(5)(2) = 66.7, P < .001). There were no important adverse events.

 Treatment of patients with cluster headache at symptom onset using inhaled high-flow oxygen compared with placebo was more likely to result in being pain-free at 15 minutes."


Doesn't say how long it works.


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