need help oxygen and energy drinks not working anymore

[alakazamela]

Please help my husband has been using oxygen to abort his cluster headaches for years now. He also relies on energy drinks to do the same when oxygen isn't available but suddenly beginning yesterday rthese methods stopped working what can he do??? he has a headache right now and it's like he is being tortured.

[Don O2]

Your husband is being tortured. I feel for you both. Does he have a non-rebreather mask,these have a bag, regulater that goes to at least 15 LPM? No outside air from holes in the mask.

The fastest way to abort with oxygen is by hyperventilating the o2 as soon as the pain starts. Waiting to see if it's a bad one, can cause a failure, with o2 and energy drinks.

Another way to use o2 is take a full breath and hold it, then exhale COMPLETELY. For me the pain will stop on the exhale.

[CHfather]

Here are two emergency things that might stop an attack or at least lessen it when O2 and energy drinks aren't helping..  Drink ice water through a straw on the CH side of his palate.  This is recommended by Batch, who knows what he's talking about. He says to try to get something like brain freeze to happen using the ice water.  The other, which works for some, is to sit/stand with his feet in a bathtub of water that's very hot. 

An ice pack might help.  If he's been using an energy drink like Red Bull, he might have better success with energy shots (such as 5-Hour Energy) which have more caffeine and taurine than the drinks (even though they are smaller).

I think it's also worth some concern when both methods that have worked for him suddenly fail that maybe he's experiencing some other condition that warrants a trip to the ER or a call to the doctor.  An injection of sumatriptan (Imitrex) will almost always stop an attack.  I understand that the ER is likely to just extend the torture and give him things that don't help.  But maybe you can insist on trex, and maybe, as I say, they might need to do some other diagnostic test (MRI, probably) to rule out it being something else. 

[xxx]

Have your husband drink a big glass of ice water... preferably through a straw,  The goal of the ice water is to create a mini brain freeze.  Chilling the hard pallet chills the sphenopalatine gangia on both sides of the nasal cavity.  As the sphenopalatine gangia are connected directly to the trigeminal ganglia where the CH pain originates this chilling triggers the vasoconstriction that is part of the cluster headache abort mechanism. Your husband should be drinking 2.5 liters of water a day.

The reason oxygen therapy and energy drinks are not effective is your husband is either suffering from an allergic reaction or a low grade infection.  Both make nearly all the classic CH interventions ineffective. 

If I suspect an allergic reaction, and they can be subclinical, i.e., no outward or obvious symptoms, I take Benadryl (Diphenhydramine HCL), 25 mg every four hours during the day and 50 mg before bed.  Diphenhydramine is a first generation antihistamine that crosses the blood brain barrier to block H1 histamine receptors on neurons throughout the brain and in particular neurons within the trigeminal ganglia.

An allergic reaction triggers mast cells to dump a flood of histamine and other proinflammatory agents into the surrounding tissues and blood stream.  This flood of histamine in turn, triggers neurons throughout the brain to release calcitonin gene-related peptid (CGRP), Substance P (SP) and vasoactive intestinal peptide (VIP). CGRP is the nasty peptide that triggers neurogenic inflammation and the pain we know as cluster headache.  CGRP, SP and VIP also trigger mast cells to dump more histamine.  This creates a circular chain reaction that continues until one or more of the reactants are consumed at which point the chain reaction and cluster headache pain ends... for now...

Pick up some Benadryl (Diphenhydramine HCL) asap this morning when the nearest supermarket opens.  In the mean time, have you husband drink the ice water then try the oxygen therapy.

I've left you a PM in your mail box with information to discuss with your husband's PCP or neurologist,  To read it, click on the envelop icon on the right side of the blue border at the top of this page.

Take care and please keep us posted.

V/R, Batch

[alakazamela]

wow, very interesting suggestions! Thank you all very much. Unfortunately he couldn't wait for these suggestions and went to his absolute last resort remedy, olanzapine, the effects of which are like a temporary coma. He usually sleeps for 2 days after taking one of these and therefore it can cause serious disruption to his life. Will try the ice water if this happens again. Don O2: he uses a rebreather mask and had to crank the O2 up to a flow rate of 20 the other day, then it just stopped being effective altogether. Very scary.

[CHfather]

8 hours ago, alakazamela said:

he uses a rebreather mask

People often are just confused about terminology, but just to be sure . . . what he wants to be using is a non-rebreather mask.  With a "rebreather" mask, some of the exhaled breath goes into the bag where it's mixed with the O2 for the next breath; with a non-rebreather, the exhaled breath does not go into the bag, so each inhale is pure O2, which is very important.