I have found that the two most recurrent periods for my cluster headaches are early afternoon after lunch (almost always if I try to take a quick nap) and of course, about an hour after I go to sleep.
I have tried O2 and various drugs, both OTC and prescription, without much success.  Strangely, I find that coffee gives better, faster relief than anything else.  It's kinda tough get out of bed to make coffee at 11:00 p.m., but it definitely seems to help, and doesn't really prevent me from going back to sleep once the headache is over.  
Also, I keep thinking maybe I can have just one beer without it triggering a headache, but I'm just kidding myself.

I too use a lot of coffee for my attacks.  In fact I will often have a cup or two before I normally get hit.  I can't really say if it does a lot of good or not, but I think it does.  What you might want to do is to make a pot before you go to bed and either keep it on, if you don't have an automatic shutoff, or prepare it with sugar,creamer, or however in a thermos so that all you have to do is pour it.  It will do me no good if I don't get it ASAP with a hit.  

Since coffee works for you, you might want to look into energy drinks with taurene, i.e. Red Bull, Monster, Rockstar, etc.  The Taurene seems to supercharge the caffeine and works more quickly for me, and doesn't give the jitters that to much caffeine can, although I can drink a pot of coffee and go to sleep.

You said O2 isn't working for you.  What flow rate are you using, and what are you using for a mask?  15lpm with a non-rebreather didn't work for me either unless I got to it befor the attack really got a hold on me.  I quit using it for a couple of years thinking it wasn't worth the effort for the relief I was experiencing, but after the convention a couple of weeks ago I started using it again at 25lpm with an Op2timask (sp?), see the oxygen info button in yellow on the left.  I'm now killing an attack in about 5 minutes, even if it has gotten up to a k5 before starting.  I could never do that before.  Check it out again and see if maybe that is the route you should take.

All the best,
Jerry

I'm very glad to see this posting, because a dose of caffeine in coffee works for me, as well.  For middle of the night events, brewing and storing in a thermos is the right way to go.  I'd hope that everyone experiencing cluster headaches for a first time would try this method of treatment before ever considering treatments with potentially gross side-effects.  It would also be great if 'purely clinical' sites on the web listed coffee as a possible treament, so that MDs doing research on behalf of patients who are first-time sufferers could suggest it.  Far as I know, a general practitioner unfamiliar with cluster headaches is not provided with coffee as an effective treatment option by websites they are likely to visit.

You kids are too young to remember when "No-Doz" was a big thing on the market. It's still available; each caplet has the caffeine of about 2C/coffee (or more).

Wonder if anyone has tried it as a fast hit without having to brew coffee???

I would think that a tablet would need to break down in your stomach before it can be absorbed. With coffee (or energy drinks) the caffeine is already in solution, ready to be absorbed.

(And Bob, I'm sure there are a number of us who remember No-Doz, having eaten them like vitamins in college.) ;D

Bob Johnson wrote on Aug 17^th, 2009 at 1:29pm:

You kids are too young to remember when "No-Doz" was a big thing on the market. It's still available; each caplet has the caffeine of about 2C/coffee (or more). Wonder if anyone has tried it as a fast hit without having to brew coffee???

Bob...you are showing your age now! ;D

I hate coffee, and pop. So that might be good for me as a daytime thing.  Thanks           lorac

Brew wrote on Aug 17^th, 2009 at 1:50pm:

I would think that a tablet would need to break down in your stomach before it can be absorbed. With coffee (or energy drinks) the caffeine is already in solution, ready to be absorbed. (And Bob, I'm sure there are a number of us who remember No-Doz, having eaten them like vitamins in college.) ;D

if your head hurts bad enuff, you will chew them up first....

JHK07 wrote on Aug 17^th, 2009 at 2:42pm:

Brew wrote on Aug 17th, 2009 at 1:50pm: I would think that a tablet would need to break down in your stomach before it can be absorbed. With coffee (or energy drinks) the caffeine is already in solution, ready to be absorbed. (And Bob, I'm sure there are a number of us who remember No-Doz, having eaten them like vitamins in college.) ;D if your head hurts bad enuff, you will chew them up first....

I didn't suffer from CH when I was in college, so there was no need to.

Bohunk,

There's likely a good reason for the increased frequency of your headaches during a nap and at sleep at night as well as why coffee helps reduce the frequency and intensity of your attacks...

For the most part, I subscribe to the vascular theory of the cluster headache disorder and it's pathophysiology where the triggering mechanism comes as a cocktail of hormones and chemicals coursing through the vascular system triggering vasodilation and the attack...  We are entitled to our opinions...

The other theory is called neurogenic where an electrochemical signal follows a nerve synapse path to the trigeminal nerve signaling dilation on the adjacent arteries and capillaries and that signals an attack... 

In the end what signals the attack is not that important...  What counts are the factors that tend to favor or counter the triggering mechanism.

It all deals with vasoactivity (dilation and constriction) of the arteries and capillaries in and around the trigeminal nerve.  If you follow this line of reasoning, the cluster headache triggering mechanism...  what ever it is...  results in a rapid dilation of the arteries in and around the trigeminal nerve.  That in tern, causes the initial pain that is vascular in nature (some times called a shadow), and when it builds due to increased vasodilation, and that dilation physically chafes the trigeminal nerve that is also inflamed at this point...  we rocket in pain from a Kip-4 or Kip-5 to a Kip-8 and above.

Sleep, particularly deep sleep at the rapid eye movement (REM) level, results in a reduced respiration rate with a shallow tidal volume.  That results a lower PaO2 (low partial pressure of arterial O2 - less oxygen in our blood) and an elevated PaCO2 (higher than normal partial pressure of arterial CO2 - more CO2 in our blood). 

These two conditions also result in a low serum pH (high blood serum acidity) and these conditions combine to become powerful vasodilators making them favor or enhance the cluster headache triggering mechanism...  At this point, the stage is set for an attack...

If you enter deep sleep, and the triggering mechanism is present or starts with body clock regularity, sleep under the conditions above, will increase the probability of an attack...

Coffee, particularly strong coffee, contains more caffeine than Red Bull, but without the taurine...  As caffeine is a vasoconstrictor, it tends to work against the cluster headache triggering mechanism.

Oxygen therapy at flow rates that support hyperventilation do three important things to help us...  100% oxygen acts as a vasoconstrictor...  And, if we breathe 100% oxygen at flow rates that support hyperventilation (flow rates ≥ 25 liters/minute), we cast off CO2 faster than our body generates it through metabolism, this lowers the concentration of CO2 (PaCO2), and that elevates the pH (less acid in the blood stream...  also call more alkaline).

The net effect is we have three powerful vasoconstrictors working for us to abort the cluster headache attack...  hyperoxia, hypocapnia, and an elevated pH. 

As an elevated pH increases hemoglobin's affinity for oxygen, This is called the Bohr Effect, that makes hyperventilating on 100% oxygen until we reach respiratory alkalosis a process that super oxygenates the blood flow to the brain signaling a rapid and powerful vasoconstriction of the arteries and capillaries in and around the trigeminal nerve...  If we continue hyperventilating on 100% oxygen, we can abort our attacks much faster with a very high success rate... 

That's my story, and I'm sticking to it until we hear differently from competent medical experts in our disorder.

Take care,

V/R, Batch

Batch wrote on Aug 17^th, 2009 at 9:07pm:

For the most part, I subscribe to the vascular theory of the cluster headache disorder and it's pathophysiology where the triggering mechanism comes as a cocktail of hormones and chemicals coursing through the vascular system triggering vasodilation and the attack...  We are entitled to our opinions.

Sure - there's a vascular component, there's a neurological component, there is an immune component, there is an ionic component.  All of these offer different ways to try to reduce the pain. I agree that on one level, it doesn't matter where 'the cause' is, provided a treatment gives some relief.  In fact, when dealing with complex systems, the idea of 'the cause' may be unhelpful.... all of the components are tied to each other and influence each other. 

I have a theory that the reason that the hypothalamus misfires is that it has too many thalamic mast cells, which dump serotonin and histamine into that part of the brain, which sends messages to the trigeminal ... maybe low oxygen levels make them more likely to release their messenger chemicals.