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Triptans and oxygen


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I mentioned this in another post here, but figured it was worth putting here, since it seems like maybe another new thing we might have learned.  In the abstract I have pasted below, it says that triptan use is a characteristic of some people for whom oxygen is ineffective.  I can't tell how effective the oxygen system used in the study was (flow rate, mask, etc.).  What I think is interesting is that we often tell people that oxygen seems to work more effectively during busting.  I think we have attributed that to the busting, but it seems possible that maybe (so many ifs and maybes, but you all understand that) it's the detox, being off triptans, that makes the O2 more effective.  Or not.

 

 

Cluster headache and oxygen: is it possible to predict which patients will be relieved? A prospective cross-sectional correlation study.
Abstract

Response to 100 % oxygen as acute treatment for cluster headache is relative low considering certain subgroups or predictors. The primary purpose of the present study was to find prospectively which factors differ between responders and non-responders to oxygen therapy. The second goal was to find whether any of these differences would clarify the mechanism of pain reduction by oxygen and cluster headache pathophysiology. Patients diagnosed with cluster headache according to the ICHD-II criteria, who started on oxygen therapy (n = 193), were recruited from 51 outpatient clinics and via patient websites in The Netherlands. Patients had to return two questionnaires around the start of oxygen therapy (n = 120). Eventually, 94 patients were included. Clear non- plus moderate responders had ever used pizotifen more often (p = 0.03). Clear non-responders more often had photophobia or phonophobia during cluster headache attacks (p = 0.047) and more often had used triptans in the same active phase as the phase in which they had used oxygen for the first time (p = 0.02). Using correction for multiple testing, we could only confirm a statistically significant difference in triptan use. We were unable to locate the level of action of oxygen in the thalamus and cortex or confirm the sites of its action presently known, solely based on current knowledge of photophobia circuits. However, we conclude that particularly the higher frequency of photophobia or phonophobia in clear non-responders deserves further study to understand the mechanism of pain reduction by oxygen and cluster headache pathophysiology.

 

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It's the detox, being off triptans. We have (finnish) patient group in Facebook (around 400 members at the moment) that is hidden and for those CH patients only that either use busting as their main treatment or plan to do so. This is one of the most obvious things noticed in our group (and keep in mind, majority have no experience in busting when they arrive) for few years now. We have not observed the other though, O2 being somehow more efficient due to busting. It is so obvious to us that we tend to promise the hits will be much easier after detoxing from triptans. It's also troublesome, outside the hidden group, since an average CH patient demands some kind of research to back this up. 

This is also one of the key pieces of such information (and there are several) that needs to be available to the patients. This is the problem (for us), that seems to grow as time passes; we have data from a patient community (such as this) that is consistent, year after year. This data is not accepted even for an evaluation in the "official" channels. And it is not allowed to share publicly without research or "official" backing up.

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