Background: Rapid recurrence of a new cluster headache attack following oxygen treatment was named the ‘rebound effect’ by Kudrow (1981). It has never been studied properly. To study this effect, we defined it as a more rapid than usual (for the individual patient) recurrent cluster headache attack after complete relief following oxygen therapy, or an increase in the number of attacks per 24 hours while using oxygen therapy as acute attack treatment. We reviewed the literature and searched our cluster headache study databases.
Case series: In our eight patients with rebound cluster headache, the effect was experienced following 87.5% of oxygen treated attacks. Duration until the next cluster headache attack was on average 894 minutes shorter and frequency was on average 1.6 cluster headache attacks per day higher than without oxygen therapy.
Conclusion: Although the 1981 trial reported a prevalence of 25%, rebound cluster headache following oxygen therapy is rarely reported nowadays. This may be due to better techniques in oxygen application, the use of higher oxygen flow rates or underreporting. The few literature data and data on our eight patients did not provide clues about the mech- anism of the rebound effect. Further study, applying the proposed definition, seems useful.
Dr. Sewell’s comment:
Those of you reading this blog will have noticed that I have not posted in a while… almost a year, in fact. Not that I’ve lost interest, mind you! Between the last post and this one, I bought a house, got married, and also was promoted to junior faculty at Yale Medical School, which carries with it a host of new responsibilities. I think that any one of those is reason enough for some time off! But things have settled down now, so I’m planning to start posting again.
We end the old year and start the new one with a paper by Dr. Geerlings from the Netherlands, who is interested in “rebound headaches” following oxygen therapy. Oxygen has been used to treat cluster headache since 1952, but as early as thirty years ago patients noticed that even though sometimes oxygen brought complete pain relief, when they stopped the oxygen another attack would soon begin—and in some indefinable way, they could tell it was still the same attack, suggesting that oxygen had only delayed the attack rather than curing it. This second attack was termed a “rebound headache”, and defined as a more rapid-than-usual recurrent cluster attack after complete relief from oxygen, or an increase in the number of attacks in the next day following oxygen therapy.
Dr. Geerlings searched through her database of 158 cluster headache patients and also did a literature search to see what she could find about rebound headaches. She found eight patients with rebound headaches (4%). On average, these eight experienced rebound headaches 88% of the time after using oxygen, usually 40 minutes later (as opposed to 16 hours later without oxygen), and they had more than four attacks per day when using oxygen as opposed to 2.5 attacks a day without oxygen. The literature search revealed that the only other doctor to describe rebound headaches was Dr. Kudrow, back in 1981, who found that a quarter of his patients who responded to oxygen also experienced rebound headaches. It’s hard to know why Dr. Kudrow found so many more—it’s possible that the higher flow rates used with oxygen nowadays prevent rebound headaches (four of the eight in this study used flow rates of 7 L/min or less), or maybe doctors nowadays just don’t ask! Oxygen is not the only treatment for cluster headache that can cause rebound headaches—sumatriptan (Imitrex) can also increase the severity and frequency of attacks over the next day.
What’s your experience?