I visited the headache clinic at Barnes in St. Louis recently, then returned to see my geriatrician, and have had six attacks in the last eight days. A bit confused and feeling stuck between a rock and a hard place. Perhaps someone here has some good advice.

These attacks began shortly after last Thanksgiving. Yesterday was quite typical. The trigger is usually some kind of stress, which leads to irritability, nervous discomfort, and then fatigue. I had to lie down for about an hour, barely able to move. By early afternoon, sinus congestion (always on the left side) and slight headache, gradually worsening if I take no medication. This is accompanied by anxiety and depression. Imitrex works well, but it's difficult to maintain an ample supply. Fiorinal helps deaden the pain, and the barbiturate makes me feel much better, but I'm taking at least one and sometimes as many as three with each attack, and I fear dependence.

I saw a local neurologist in January, and he diagnosed cluster headache with some aspects of migraine, prescribing Verapamil (240 mg per day). Similarly, the doctors at Barnes diagnosed TAC (trigeminal autonomic cephalgia), and suggested increasing my Verapamil and using oxygen. But from all I read here, these don't sound like cluster headaches to me -- e.g., they come on gradually, pain is mild to moderate, duration is indefinite, etc.

When I returned from Barnes and spoke to my geriatrician, she resisted increasing my Verapamil because I have low blood pressure and an extremely slow heart rate (45 bpm). In fact I've always had a slow pulse (I'm 65 but was very athletic when I was younger), but never this low. I've tried a couple of times going down to 120 mg of Verapamil, but the attacks seem to come back, so I've returned to 240 mg.

One other possibility concerns serotonin. I began reading about serotonin and suspected that my levels were low. A blood text confirmed a low level (10), and my geriatrician put me on an SSRI (Celexa) which seemed to help. But the doctors at Barnes pointed out that there is no clear relation between blood and brain serotonin levels, and that the decreased frequency and intensity of my attacks could be the result of other factors. They suggested melatonin, more Verapamil, oxygen, and so on.

I'm able to sleep with 1 mg of Lorazepam each night, and I also take Allegra and use Flonase.

With all this conflicting medical advice and various drugs, I'm feeling a bit jerked around.

Sorry to go on so long. I'll be grateful for any advice anyone has.