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Dear Mayo Clinic:
I had an extremely painful headache that was diagnosed as a cluster headache in the emergency department. I was treated with oxygen, and the pain disappeared.
Is it common to treat headaches with oxygen, or is this a treatment specific to this type of headache?

A: If you have cluster headaches and begin having a painful attack, a common and established therapy is using 100 percent oxygen delivered with a face mask. This often relieves the pain within about 15 minutes.

Oxygen isn’t known to be useful in other types of headaches. For example, although oxygen has been investigated for treating migraines, there’s no good evidence supporting this use.

Cluster headaches are very severe, debilitating headaches on one side of the head that last for 15 minutes to three hours when untreated.

On the same side as the headache, there is often redness of the white of the eye, tearing from the eye, stuffiness or runny nose, swelling of the eyelid, and abnormal sweating of the forehead or face.

Cluster headaches typically occur at the same time each day, including attacks that awaken people at night. It is common for there to be a sense of restlessness or agitation during a cluster attack.

These headaches are called cluster headaches because they often occur in bouts of frequent attacks (cluster periods) that can last from weeks to months, usually followed by remission periods that can last for months and sometimes years.

The cause of cluster headaches isn’t completely understood. That said, the pattern of these types of headaches suggests that abnormalities in the body’s biological clock could play a role, likely mediated by a part of the brain called the hypothalamus.

When available, oxygen is usually the preferred therapy for a cluster headache attack. Oxygen has no side effects and can work quickly.

It can be administered in an emergency department setting, or at home using an oxygen cylinder and regulator.

When the oxygen cylinder is not readily available, such as when outside the home, medications called triptans can be used. Since the treatment of a cluster attack must work quickly, use of an intranasal or injectable triptan is typically preferred over tablets taken by mouth.

— Todd Schwedt, M.D., Neurology, Mayo Clinic, Phoenix

Dear Mayo Clinic:
My doctor says that exercise is even better than calcium supplements for helping maintain bone density and prevent fractures. Can you explain why?

A: Both calcium and physical activity are important for bone health. But when you consider the net benefits of calcium, especially in supplement form, it’s unlikely to serve as a good substitute for regular exercise.

Calcium is an important mineral that your body uses to build and maintain strong bones. Foods that are high in calcium include dairy products, dark green leafy vegetables and certain fish, such as sardines.

Various foods and beverages, such as cereals and fruit juices, may be fortified with calcium and vitamin D, as vitamin D enhances absorption of calcium.

Calcium in supplement form may help people who can’t get enough calcium from their diet or those who poorly absorb calcium because of conditions such as untreated celiac disease or bariatric surgery.

However, recent evidence suggests that increasing calcium intake through supplements has a modest and limited effect on bone density.

Calcium supplements also can have certain side effects. They can cause constipation, interfere with other drugs and, at higher doses, may be linked to the development of kidney stones.

Studies even suggest a potential link between excessive amounts of calcium and conditions such as heart disease and prostate cancer.

On the other hand, regular exercise that uses a variety of muscle groups and includes some strength training helps you build a protective framework around your skeleton.

It also helps you move more easily and improves your balance. Exercise helps decrease your risk of falling and breaking a bone, which is the ultimate concern.

Ingesting the recommended daily amounts of calcium primarily through dietary sources and staying physically active appear to be the best approaches to limit your fracture risk.

— Matthew T. Drake, M.D., Ph.D., Hematology, Mayo Clinic, Rochester, Minn.

Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. E-mail a question to MayoClinicQ&A@mayo.edu. For more information, visit mayoclinic.org.
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