Hi All,

Not sure if I've posted before, but it's been years since i've logged on, so i'm essentially new to the site.  Quick profile:
35yrs old, male, married with 2 kids.  Been a clusterhead for 15 years, episodic, occuring every 18-24 months and lasting for 6-8 weeks.  for most of the past 15 years i've lived in the developing world and have never had any real medical assessment besides a cat scan which revealed nothing in particular.  For treatment i try heavy doses of caffeine (red bull, iced coffee, etc) to abort at the first sign, and then subsequently take imitrex in pill form once the pain sets in.  50mg is usually sufficient, or 100mg if not.  Only on rare occassions does 100mg of imitrex not do the job in 20 minutes or so. 

currently i live in Amman jordan and i've just discovered that there is no imitrex or sumatriptan based drug available in the country.  i have 2 pills left which will likely last me 2-3 days max.  (i didn't expect another attach till spring which would've given me time to get home and restock). i'm getting pretty nervous about what's in store for me and eager to try something/anything new.  left untreated the headaches can last up to 4 hours per attack. 

my question for the group is: does anyone know a good specialist in the region (jordan, israel, lebanon, syria)? and if not, how do i go about finding a specialist who can help? (i.e. other than searching for a neurologist, are there some key terms that can help me identify someone who might have CH expereince?)

much thanks in advance

While this article won't help you directly, the techniques of WHERE to look may help.
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LOCATING HEADACHE SPECIALIST

1. Search the OUCH site (button on left) for a list of recommended M.D.s.

2. Yellow Pages phone book: look for "Headache Clinics" in the M.D. section and look under "neurologist" where some docs will list speciality areas of practice.

3.  Call your hospital/medical center. They often have an office to assist in finding a physician. You may have to ask for the social worker/patient advocate.

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The list of meds from Europe may suggest products available to you.

HERE ARE TWO MAJOR DOCUMENTS WITH RECOMMENDED TREATMENTS FOR CLUSTER HEADACHE, ONE FROM A U.S. PHYSICIAN, THE SECOND FROM EUROPE.
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Here is a link to read and print and take to your doctor.  It describes preventive, transitional, abortive and surgical treatments for CH. Written by one of the better headache docs in the U.S.  (2002. Rozen)
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Treatment guidelines from Europe

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A. May, M. Leone, J. Áfra, M. Linde, P. S. Sándor, S. Evers, P. J. Goadsby:
EFNS guidelines on the treatment of cluster headache and other
trigeminalautonomic cephalalgias.
European Journal of Neurology. 2006; 13: 1066–1077.

Download free full text:
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(Thanks to "cluster" for link.)
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This abortive may be available (seek under its generic, not trade, name. A number of us have found it very effective.
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Headache 2001 Sep;41(8):813-6 

Olanzapine as an Abortive Agent for Cluster Headache.

Rozen TD.

Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. THE INITIAL OLANZAPINE DOSE WAS 5 MG, AND THE DOSE WAS INCREASED TO 10 MG IF THERE WAS NO PAIN RELIEF. THE DOSAGE WAS DECREASED TO 2.5 MG IF THE 5-MG DOSE WAS EFFECTIVE BUT CAUSED ADVERSE EFFECTS. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache-free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. IT ALLEVIATES PAIN QUICKLY AND HAS A CONSISTENT RESPONSE ACROSS MULTIPLE TREATED ATTACKS. IT APPEARS TO WORK IN BOTH EPISODIC AND CHRONIC CLUSTER HEADACHE.

PMID 11576207 PubMed

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Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.

Hi Jahras,

Well the newer approach to self administering oxygen a la the "oxygen info" link on the left side of the forum view here certainly seems to be all the rage with the regulars here.

Any chance you could get O2 there?

This next idea is more obscure, but very simple to try:

Breathing very cold air.

I've aborted attacks by doing just this after reading about it online maybe 12-13 years ago, I think at some predecessor to this forum. If the weather isn't cooperating I hop in the car, crank the AC, put my nose right on a vent and breathe deep. After 10 minutes or so, an ice cream headache will have replaced the CH, and oh what a joy an ice cream headache can be!

Not guaranteed but maybe worth a try if you have access to AC??

Thanks to both.  Not a lot of cold air here, but i'm well invested in ACs, so happy to give that a try.  I've read up on the oxygen treatment and eager to try as well.  i've heard the O2 is available but i'll have to investigate some.  thanks again for the advice and direction!

Jahras I'm away from home until tomorrow. I met a wonderful caring neuro from Israel in September who was very compassionate about people suffering from CH. I will post his details on here for you when I get home tomorrow in the hope you can get help.
Helen

wrote on Nov 9^th, 2009 at 2:37pm:

...a wonderful caring neuro from Israel in September who was very compassionate about people suffering from CH. I will post his details on here..... Helen

Does this message board ROCK or what??  :)

Way to go LeLimey.  8-)