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

Abstract

Therapeutic response to inhaled oxygen at sufficiently high flow rates (>10 L/min) had comparable efficacy to that of injectable sumatriptan for the acute treatment of cluster headache. Other factors in oxygen delivery (ie, flow rate changes) should be explored for optimization of therapy. The reasons for improved oxygen response in males and those with a cigarette smoking history require further exploration. While both oxygen and sumatriptan can be effective in the management of cluster headache, patient-reported side effects and concerns were more commonly directed at triptan medications. Current restrictions on access to inhaled oxygen, which exist at many levels, limit the therapeutic options available for patients with cluster headache, thereby doing a disservice to this patient population and the providers who deliver their care.

Effectiveness of Oxygen and Other Acute Treatments for Cluster Headache: Results From the Cluster Headache Questionnaire, an International Survey

“…Oxygen responsiveness has been positively associated with shorter attacks and a lack of interictal pain, and negatively associated with photophobia or phonophobia during an attack, nausea and vomiting during an attack, or restlessness . Previous studies have found conflicting results for associations with age, sex, and history of smoking . Our findings show no association of responses to any acute therapies with any cranial autonomic features examined (rhinorrhea was not examined) and no association with restlessness, photophobia/phonophobia, nausea/vomiting, age (current age or age of onset of cluster headaches), sex, or any other feature examined.…”

“…While oxygen is highly effective, it may not be the most effective treatment because all triptans were grouped together. Subcutaneous sumatriptan may be more effective than oxygen based on some previous questionnaires, though a questionnaire that specifically compared oxygen >10 L/min to injectable sumatriptan found no difference in effectiveness . Thus higher doses of oxygen at 10‐15 L/min or more, which are used in clinical practice, may be the most effective doses of oxygen.…”

“…The effectiveness of oxygen for cluster headache attacks ranges between 56% and 82% across multiple controlled and open‐label trials, as well as clinic and non‐clinic based questionnaires . This study is a non‐clinic based questionnaire showing oxygen as completely effective in 13%, very effective in 41%, somewhat effective in 27%, minimally effective in 12%, and completely ineffective in 7%.…”

Recent Advances in the Management of Cluster Headache

“…The effectiveness of high-flow oxygen in CH is remarkable; it is well tolerated with few adverse events; it is applicable repeatedly throughout the day and can also be combined with other treatments [16,19,20]. The major drawback for oxygen use is the portability of the cylinders [21].…”

“You will eat shoe polish if you think it would help”—Familiar and lesser‐known themes identified from mixed‐methods analysis of a cluster headache survey

“…Clusterbusters sought to examine some of these topics in their Medication Use Survey, which was a large online survey executed in 2012 and published previously by authors EADS, DAW, and MJW. 2,5 In the current report, we analyzed the free-text comments provided by survey participants and used qualitative and quantitative techniques to identify themes that were not queried within the structured survey questions. The hypothesis of this exploratory project was that topics about cluster headache that are not widely known would be identified.…”