Oxygen therapy for cluster headache (Horton's headache)

Information for healthcare professionals

Here you will find information on oxygen therapy for cluster headache. Information on how to prescribe oxygen cylinders and Horton's Demand Kit.

Horton's Headache

Horton's Headache (also known as Cluster Headache) is a primary headache that is both underdiagnosed and undertreated ¹. Although the disease has a fairly typical clinical picture, diagnosis is often delayed or missed altogether ².
1.Petersen Anja S, Barloeses Mads CJ and Rigmor H Jensen. Oxygen Treatment of cluster headache: A review. Cephalalgia. November 2014 vol. 34no. 13 1079-1087
2.Voiticovschi-Iosob C et al. Diagnostic and Therapeutic errors in cluster headache: a hospital based study. The Journal of Headache and Pain 2014; 15:56

Test Kit information for healthcare professionals

Do you have patients with Cluster Headache who have not yet had a try with medical oxygen for their headache attacks? To know if your patient will benefit from the treatment, prescribe a test kit and let the patient try it at home during the next attack.
A test kit consists of:
1. A small portable gas cylinder - choose a 2 litre LIV cylinder
2. Equipment with valve and mask/nozzle in one package - Horton's demand starter kit

Please include a quick guide customised for Cluster Headache patients with instructions to easily get started with treatment.
Click here for the quick guide.

Hortons Demand - Equipment

Horton's Demand is a device specifically designed for patients with Cluster Headache. It consists of a demand valve and a face mask or mouthpiece, which is connected to the oxygen cylinder. The demand valve provides oxygen only when inhaled, thus reducing the consumption of gas. At the same time, it minimises the risk of oxygen leaking out when the equipment is not in use. Horton's demand equipment is prescribed on prescription and is approved by TLV and included in the pharmaceutical benefit.
Horton's demand equipment is supplied in a starter kit which, together with the oxygen cylinder, is all that is needed for the oxygen treatment. The starter kit is designed to eliminate the need to keep track of the different parts and to ensure that the patient has easy access to everything needed to start treatment.
Cluster Demand Starter Kit
Item number at the pharmacy: 22 06 07
Downloadable product sheet
Downloadable quick guide

The demand valve only provides oxygen when inhaled, which saves gas and minimizes the risk of leakage.

Article number: 329 149. The nozzle can be replaced if necessary.

Article number: 321 588. The exhalation valve has a built-in hygiene filter and must be replaced after 30 days. It attaches between the demand valve and the mouthpiece/face mask.

The operating instructions explain how the equipment works and show how it is connected to the oxygen cylinder. Encourage the patient to read the instructions for use and safety instructions carefully before use.

Article number: 329 399 The face mask will be replaced if necessary.

In the places where oxygen is stored, both at home and at the workplace, there must be a warning triangle on the inside of the front door that informs the emergency services in the event of a fire. Read more about safety instructions.

How it works - Horton´s Demand

Horton's demand is easily connected to the oxygen cylinder's quick-connect socket:

1. Push the hose with the connector into the socket on the cylinder.
2. Check that it is secure by pulling lightly on the hose.
3. Turn on the gas and start the treatment.

The exhalation valve is installed either between the demand valve and the face mask or between the demand valve and the mouthpiece.
Download the quick guide:
● Get started with Horton's Demand and the LIV bottle.
● Click here for the quick guide video.

Safety instructions

● Oxygen should not be used for any purpose other than that for which it was prescribed and only the connectors intended for medical oxygen should be used.
● Instruct the patient never to place a face mask or nose clip directly on textiles, such as clothing or bed linen, when the oxygen is on. Oxygen can ‘saturate’ the textiles and make them flammable and combustible. Textiles suspected of being saturated with oxygen must be shaken and ventilated thoroughly. It is not enough to simply air them.
● Oxygen can accumulate in clothes and hair. Therefore, air and shake out clothing, brush through hair/beard growth and wait 15 minutes after completion of oxygen treatment before using equipment with a filament (toaster, hairdryer) or that otherwise uses fire.

Warnings:
● Smoking and open flames are prohibited in a room where oxygen therapy is in progress, as they increase the risk of fire.
● Do not use a toaster, hairdryer, or similar equipment with a filament during oxygen therapy.
● Switch off the equipment in case of fire.

Oxygen cylinders - Information for healthcare professionals

The oxygen cylinders are called LIV (Linde Integrated Valve) and are available in three different sizes depending on your needs. The frequency and duration of headache attacks determine how much oxygen is needed. There are also different accessories for the different cylinders.

● Pharmacy product number: 45 54 35
● Bottle size: 10 litres
● Nominal content: approx. 2120 litres
● Weight incl gas: approx 14.2 kg

The LIV ® Mini 1.1 L weighs only about 2.5 kg and is particularly suitable for patients who suffer from headache attacks frequently and in different places. The bottle holds approximately 233 litres and is used with Horton's demand, which means that the oxygen is sufficient for treatment for approximately 6 minutes depending on the breathing rate. CONOXIA 100 %.

● Pharmacy product number: 51 60 97
● Bottle size: 1.1 litres
● Nominal content: approx. 233 litres
● Weight incl. gas: approx. 2.5 kg

LIV ® Mini 2 L weighs about 3.8 kg and can be taken to work or the summer cottage. The bottle holds about 420 litres and is used with Horton's demand, which means that the oxygen is sufficient for treatment for about 10-15 minutes depending on the breathing rate. CONOXIA 100 %.

● Pharmacy product number: 07 63 61
● Bottle size: 2 litres
● Nominal content: approx. 420 litres
● Weight incl. gas: approx. 3.8 kg
● Supplied in HANDYPACK that holds 1-4 bottles

Read more:

● Downloadable product sheet
● Downloadable leaflet on instructions and safety

LIV® Maxi 10 L

LIV ® Mini 1,1 L

LIV ® Mini 2 L

LIV® Maxi 10 L

LIV® Maxi 10 L is a lightweight cylinder specifically designed for home oxygen treatment of Horton's headache. The cylinder holds approximately 2120 litres of oxygen and is sufficient for the treatment of 8-15 headache attacks when used with Horton's demand. CONOXIA 100 %.
● Pharmacy product number: 45 54 35
● Bottle size: 10 litres
● Nominal content: approx. 2120 litres
● Weight incl gas: approx 14.2 kg

Writing a prescription.
Information for healthcare professionals.

●Find out which products you should prescribe.
●For home oxygen therapy choose:
CONOXIA 100 %. Lättviktsflaska LIVMaxi 10 L®,item number 45 54 35
●If you also want to provide the patient with a portable bottle, you can add CONOXIA 100%. Lättviktsflaska LIV Mini 2 L®,item number 07 63 61
●The equipment needed for:
Hortons demand startpaket, varunummer 22 06 07
●Search for the products in the e-prescription system.
●Or use the free text box. If you cannot find any of the products in the e-prescription system, enter the product name and item number in the free text box instead.
●Write your prescription for the patient in the free text box. You do not need to indicate the dosage in litres/minute as the patient's inhalation controls the gas flow.

Checklist to go through with the patient

●How does the demand valve and mask work
●Connection to oxygen cylinder
●Safety and security
●Apothecary - orders & delivery
●Quick guide -for the patient
●Patient leaflet -download or order

Do you need help with instructions on how to use an oxygen cylinder with a Horton's Demand kit and safety instructions for your patient? Linde's therapy specialists can help. For more information, please contact Linde's customer service on tel. 08-731 1800.

How does the delivery work?

Once you have sent the e-prescription, the patient contacts their pharmacy to activate the prescription. The pharmacy then orders the oxygen via Linde Healthcare's customer centre tel. 08-731 18 00. Linde Healthcare has deliveries 1-3 times a week depending on where in the country you live.

Travelling with oxygen

Travelling in Sweden
If the patient is travelling within Sweden, the oxygen can be delivered directly to the destination. In this case, it is important that the patient contacts their pharmacy in good time before departure to order the oxygen.

Travelling abroad
For travelling abroad, Linde Healthcare has a partnership with Oxytravel - which coordinates oxygen deliveries around the world. Please encourage the patient to contact Oxytravel as far in advance as possible before travelling. Email: oxytravel@oxygenworldwide.com
Telephone: +34-676 14 12 13
Fax: +34-96 688 28 55