In Reply: Dr Haghshenas and colleagues question our decision to use a relatively high dose of oxygen for treatment of cluster headache. We moved from lower to higher flow rates for our study because of pragmatism. It has been our experience in clinical practice that high flow rates tend to be more effective, so we considered it logical to maximize our opportunity to see an efficacy signal.
Having now established efficacy for oxygen treatment in a properly controlled and powered study, we agree that it would be useful to determine the efficacy of lower doses of oxygen. We note that the logistics of employing mass spectrometry at home are challenging, and having patients stay at a study site over time would require considerable resources. We agree this resource should be made available and are actively seeking such support.
Cohen AS, Goadsby PJ. High-Flow Oxygen for Cluster Headache—Reply. JAMA. 2010;303(15):1481. doi:10.1001/jama.2010.442