Treatment · Acute
Oxygen therapy for cluster headache in New Zealand
High-flow oxygen is the single most effective acute treatment for cluster headache. It aborts attacks in 70–80% of patients within 15–20 minutes, with no significant side effects.
If you are in the middle of an attack, go to the attack page for immediate steps, or open the low-glare oxygen timer. Come back here once the attack has passed to sort out your ongoing supply.
Every Health NZ district has now answered our questions about funded oxygen for cluster headache. Check your district on the oxygen access map.
- A first-line acute treatment in the European Academy of Neurology (EAN) 2023 cluster headache guideline.
- Delivered as 100% oxygen at 12–15 L/min through a non-rebreather mask.
- No cardiovascular contraindications, so it can be used for every attack.
- Classed as a medical gas in NZ, so it needs a supplier account to access.
- Tell your doctor if you have a history of severe lung disease before using high-flow oxygen.
Why oxygen works
Cluster headache attacks involve vasodilation and activation of the trigeminal nerve. Breathing 100% oxygen at high flow constricts cerebral blood vessels and appears to inhibit trigeminal activation, aborting the attack before it peaks. Unlike sumatriptan, oxygen has no cardiovascular contraindications and can be used for every attack without concern about overuse. If you have severe lung disease such as advanced COPD, tell your doctor, as high-flow oxygen occasionally needs extra care.
What you need
Three pieces of equipment matter. The mask is the part most often gotten wrong.
Keeping oxygen safe at home
Oxygen does not burn on its own, but it makes anything nearby burn far more fiercely, so keep well away from cigarettes, vapes, flames and other ignition sources while it is running, and away from oils or petroleum-based products such as petroleum jelly on your face or hands. Store the cylinder upright and turn it off at the valve when you finish.
Using oxygen during an attack
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Start at the first sign
Begin oxygen immediately. Do not wait for the pain to escalate.
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Set 12–15 L/min
Turn the regulator to a high flow rate and fit the non-rebreather mask.
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Breathe deeply, stay upright
Breathe normally and deeply. Sit upright or pace; do not lie down. Many patients find movement or rocking helps.
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Continue up to 20 minutes
Most patients who respond do so within 15 minutes. Keep going to 20 if needed.
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No response? Use your rescue
If there is no relief after 20 minutes, try a sumatriptan injection if available.
Many patients do better when they fully exhale, seal the mask well, and breathe 100% oxygen with deliberate deep breaths rather than shallow ones.
- Non-rebreather mask with reservoir bag
- 12–15 L/min (or higher) flow rate
- Starting at the very first sign of an attack
- Simple face masks or nasal cannulas
- Nasal cannula, or a mask without a reservoir bag
- Waiting until the pain has peaked
Getting oxygen access in New Zealand
There are two routes to a home oxygen supply: a funded supply through Health NZ's community oxygen service, or a private, self-funded account with a supplier, which does not require a prescription. The private route is quick and well understood. The funded route is confirmed to exist, but the practical route varies by district. Check the CHNZ oxygen access map for the latest district notes, and be prepared for your local service to be unfamiliar with cluster headache oxygen. Many patients set up a private supply first and pursue the funded route in parallel.
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Confirm your diagnosis
Your GP needs a confirmed diagnosis of cluster headache before prescribing oxygen. If you do not have one, ask for a neurology referral. See diagnosis in New Zealand.
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Ask your GP to prescribe oxygen
Bring the GP fact sheet PDF to your appointment. The prescription should specify:
- Indication: cluster headache (acute treatment)
- Flow rate: 12–15 litres per minute
- Delivery: via non-rebreather mask
- Equipment: home oxygen cylinder with high-flow regulator
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Contact an oxygen supplier
Contact a medical oxygen supplier. The main NZ suppliers are Air Liquide Healthcare and BOC Healthcare. Your GP practice or pharmacist can advise the current local provider. The supplier arranges cylinder delivery and pickup.
For a private, self-funded supply, BOC has confirmed (July 2026) that no GP or specialist documentation and no prescription are required, as medical oxygen is treated similarly to an over-the-counter product such as paracetamol. All you need is a BOC account, which can be set up online or via a fillable PDF form sent to BOC's sales team. This removes a barrier many patients assume exists.
If you would prefer to pursue a publicly funded supply instead, ask for a letter confirming the diagnosis and the need for high-flow oxygen for acute attacks, and see the funding note below. Requirements and pricing change, so confirm the current process, equipment options and costs directly with the supplier before ordering.
BOC does not stock cluster-headache-specific masks or demand valves. Their standard offering is a general-purpose flow regulator and cylinder. This is why many patients pair a BOC (or Air Liquide) cylinder with a purpose-built mask such as the ClusterO2 Kit ordered separately. See the equipment checklist above.
Health NZ (Te Whatu Ora) has confirmed in writing that it funds high-flow oxygen for the acute treatment of cluster headache. In an Official Information Act response to Cluster Headache NZ dated 27 July 2026 (reference HNZ00205131), Health NZ said:
“Health NZ does fund intermittent high-flow oxygen for this purpose under Community Oxygen Therapy Services. It is administered through Community Services who manage the supply to people in their homes.”
As far as we are aware, this is the first time Health NZ has stated the funding position in writing in response to a direct question. If you have been told that oxygen for cluster headache is not available or not funded in New Zealand, that is not correct. You can quote the answer above to your GP, along with the reference number. You can also read the letter yourself: our Official Information Act requests and Health NZ's full written responses (PDF).
Health NZ also confirmed that this treatment is not funded by PHARMAC. PHARMAC told us the same thing in its own response of 24 July 2026. Funding sits with Health NZ, through the community oxygen service in your district.
The clinical basis is well established. The Thoracic Society of Australia and New Zealand (TSANZ) 2024 home oxygen guideline gives a strong recommendation for intermittent inhaled high-flow oxygen (100% at 10–15 L/min via a non-rebreather mask) to treat acute cluster headache attacks and acute migraine. The European Academy of Neurology 2023 guideline and NICE guideline CG150 both recommend it as a first-line acute treatment. Health NZ has pointed to its national community oxygen service specification, and to that document's reference to current TSANZ guidance, as the basis on which cluster headache falls within the service.
What this means for you. A blood gas test is generally not required to start treatment, and a neurology referral is not required either: a GP can prescribe and administer oxygen for an acute attack directly. For ongoing home oxygen, the referral goes to your district's respiratory service once your diagnosis is confirmed. Funded access is real but still uneven from district to district. Every Health NZ district has now answered. Check your own district's current route on the oxygen access map, and if your district is unfamiliar with this, show them the Health NZ funding confirmation above.
If you would rather not wait on a funded pathway, arranging a private, self-funded supply is straightforward: BOC has confirmed no GP or specialist documentation and no prescription are required for a private account (see the step above). Many patients arrange a private supply first, and separately ask their GP for a referral to their district community oxygen service to pursue funded ongoing access.
Oxygen concentrators are sometimes suggested as an alternative to cylinders, but they are not suitable for cluster headache. The problem is purity, not just flow: a concentrator draws in room air and separates out the oxygen, and the concentration it delivers falls as the flow is turned up. The TSANZ 2024 guideline notes that stationary concentrators typically reach 5 L/min, with some reaching 10 L/min, “although the percentage of oxygen falls with increasing flow rate”. BOC confirmed in July 2026 that the concentrator it can supply reaches about 10 L/min. Cluster headache treatment depends on close to 100% oxygen, so a cylinder with a high-flow regulator remains the option that reliably delivers it.
Portable oxygen away from home
Attacks can occur anywhere. Small portable cylinders come from the same suppliers as your home cylinder and are compact enough for a car or bag: a lifeline away from home. Ask your supplier about portable options when you set up your home supply.
Combining with sumatriptan
Oxygen and sumatriptan are complementary and have no interaction. If oxygen is only partly effective or runs out, a sumatriptan injection can be used as a rescue. Some patients use both routinely.
If your GP is unfamiliar with oxygen for cluster headache
Many GPs are not aware that oxygen treats cluster headache, or are unfamiliar with prescribing medical gases. This is not uncommon. You can:
- Share the GP fact sheet PDF from this website.
- Ask your GP to refer directly to your district's community oxygen or respiratory service - Health NZ has confirmed a neurology referral is not required to start treatment.
- Check the oxygen access map for your district's current route notes.
- Call Healthline on 0800 611 116 (free 24/7 nurse advice) if you would like general health guidance while you sort out a supply.
- Contact us if you are having difficulty. We can provide additional support resources.
If you are newly diagnosed, getting oxygen set up is one of the most important things you can do. It takes a little effort the first time, but once you have a home supply and a portable cylinder in your car, the difference to your quality of life during a cluster period is substantial. Read about sumatriptan injection as a complementary acute treatment, and verapamil as the main preventive option in New Zealand.