Demand Valve Oxygen: A Promising New Oxygen Delivery System for the Acute Treatment of Cluster Headache

Abstract

Demand valve oxygen appears to be an effective acute treatment for cluster headache. All subjects became headache-free. Time to pain freedom was fast (average 12 minutes). The small number of study subjects does not allow a direct comparison of efficacy between demand valve oxygen and continuous high flow oxygen.

Survey Analysis of the Use, Effectiveness, and Patient‐Reported Tolerability of Inhaled Oxygen Compared With Injectable Sumatriptan for the Acute Treatment of Cluster Headache

“…The changing of flow rates during the attack was not queried in this survey, though the success of the demand valve system may speak to this point. The demand valve system provides an oxygen flow rate based on respiratory rate and tidal volume and may have benefits over the classic NRB mask in level of effectiveness, response time, patient preference, and reduced need for rescue medication . The success of the demand valve system (in the present study it was 93.3% effective) may in part be influenced by its innovation and purported increased efficacy.…”

“… The exact flow rate of 10 L/min could not be identified in the analysis as survey response choices included inclusive ranges (ie, “7‐10 L/min” and “10‐15 L/min”). This limitation does not minimize the essence of the findings, however, as patients often change flow rates manually during attacks or prefer the demand valve system . In addition to inquiring about flow rate changes, future studies should include the following factors: time of initiation (early vs peak pain), duration of inhalation, time of onset of efficacy, and duration of stated efficacy.…”

Treatment of cluster headache

“…[ 7 8 ] More recently, a demand valve has been investigated in an open-label pilot study of four patients using a demand valve with promising results. [ 9 ]…”

Economics of Inhaled Oxygen Use as an Acute Therapy for Cluster Headache in the United States of America

“…Studies report that most patients experience complete or nearly complete relief within 15‐20 minutes of high‐flow oxygen inhalation with a non‐rebreather mask. This is accompanied by a reduction in the need for a rescue analgesic and increased positive effects on associated autonomic symptoms . Evidence‐based clinical guidelines in several countries, including the USA, recommend the administration of oxygen through a non‐rebreather facemask at a flow rate of 6‐15 L/minute for up to 20 minutes for termination of an attack .…”

“…This is accompanied by a reduction in the need for a rescue analgesic and increased positive effects on associated autonomic symptoms. [13][14][15] Evidence-based clinical guidelines in several countries, including the USA, recommend the administration of oxygen through a non-rebreather facemask at a flow rate of 6-15 L/minute for up to 20 minutes for termination of an attack. [16][17][18][19][20][21][22] Of note, these recommendations are different from oxygen requirements for other conditions, such as chronic obstructive pulmonary disease, where a nasal cannula and low flow rate are used.…”