Dear MMayo,
I, fortunately, am episodic.  I can only take my worst day and times it by 365 to understand how a chronic suffer feels.  I have the up most respect and sympathy for them.
You are a strong kid to watch your father like that for 18 years. And then your father is even stronger.
You came to right place, be patient, and some really good advice will come your way very soon, promise.

To make your father's imitrex last longer, read this:
Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

Wishing your family PFD! (pain free days)
Angela

I agree that your father has intense and unshakeable CH's, but if the 2mg doesn't then try 2mg more.  If a fraction can work, then a fraction is saved.

Sometimes the Imitrex doesn't work for me either, or I get those nasty rebound headaches.  Then I just have to ride the headache out (say's the episodic sufferer).

Hang in there, some one more familiar with chronic CH and who has tried more options than me, will be by.
Angela

As of 5-min ago, this is the latest report on the topic. Clearly, not an intense area of search yet....

Headache. 2006 Jun;46(6):925-33. 


Testosterone replacement therapy for treatment refractory cluster headache.

Stillman MJ.

Objectives.-To describe the clinical characteristics and laboratory findings of cluster headache patients whose headaches responded to testosterone replacement therapy. Background.-Current evidence points to hypothalamic dysfunction, with increased metabolic hyperactivity in the region of the suprachiasmatic nucleus, as being important in the genesis of cluster headaches. This is clinically borne out in the circadian and diurnal behavior of these headaches. For years it has been recognized that male cluster headache patients appear overmasculinized. Recent neuroendocrine and sleep studies now point to an association between gonadotropin and corticotropin levels and hypothalamically entrained pineal secretion of melatonin. Results.-Seven male and 2 female patients, seen between July 2004 and February 2005, and between the ages of 32 and 56, are reported with histories of treatment resistant cluster headaches accompanied by borderline low or low serum testosterone levels. The patients failed to respond to individually tailored medical regimens, including melatonin doses of 12 mg a day or higher, high flow oxygen, maximally tolerated verapamil, antiepileptic agents, and parenteral serotonin agonists. Seven of the 9 patients met 2004 International Classification for the Diagnosis of Headache criteria for chronic cluster headaches; the other 2 patients had episodic cluster headaches of several months duration. After neurological and physical examination all patients had laboratory investigations including fasting lipid panel, PSA (where indicated), LH, FSH, and testosterone levels (both free and total). All 9 patients demonstrated either abnormally low or low, normal testosterone levels. After supplementation with either pure testosterone in 5 of 7 male patients or combination testosterone/estrogen therapy in both female patients, the patients achieved cluster headache freedom for the first 24 hours. Four male chronic cluster patients, all with abnormally low testosterone levels, achieved remission. Conclusions.-Abnormal testosterone levels in patients with episodic or chronic cluster headaches refractory to maximal medical management may predict a therapeutic response to testosterone replacement therapy. In the described cases, diurnal variation of attacks, a seasonal cluster pattern, and previous, transient responsiveness to melatonin therapy pointed to the hypothalamus as the site of neurological dysfunction. Prospective studies pairing hormone levels and polysomnographic data are needed.

PMID: 16732838 
=====================
I've seen, in just the last few weeks, a couple of reports trying this med as a preventive as well as an abortive. As an abortive, a number of us find it 100% effective.

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

--------------------------------------------------------------------------------


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.

Has he tried Verapamil as a preventative?  It takes awhile to work, but many have good results.  I guess my next question would be to ask how long of a trial and at what doses did all of these medications/treatments fail?  Is his blood pressure running too high...that kept me in a worse shape one time with my headaches and it was amazing that treating that helped my head so much!  All the pain had made my blood pressure high and I didn't know it until my internist caught it.  I also don't remember now if you mentioned he had tried Prednizone.  That would be my last resort, but it sounds like he needs a last resort.

Good luck!
Joni

Sorry, I'm out of ideas.  I am episodic, though I have had the frustration with medications as well.  I see now that he is going to the hospital to get steroids (Prednizone).  Surely that will help.  I have to be really careful tapering off of them as to not start another round.  Seems to me like he needs a preventative to kick in after the steroids wear off/taper off.  It is difficult for me to believe that Vit D will stop his headaches, however, it is very good for you and a lot of people are low.  I am and took an Rx for 8 weeks, then 2000iu every day since.  It didn't affect my recent cycle, though, I had a whopper anyway.  Maybe others on here can help you.

have to say your dad is lucky to have you.  If you are looking for last resorts, check out clusterbusters.com

Also, I have to say my last cycle was the easiest I ever had and it was WITHOUT anything but O2.

Speaking of o2, let us know EXACTLY how he was using it.  Need the proper flow and proper mask

I'm straining, rooting around the cellar, for a new (old) approach, when I offer this article. But sometimes a new perspective is useful.....
=============

--------------------------------------------------------------------------------

Title: "Cluster Headache Mimics"--useful article. Post by Bob_Johnson on Jul 30th, 2004, 2:04pm
--------------------------------------------------------------------------------

This is an important article to obtain and take to your doctor if you are having a difficult time getting a diagnosis of the type of headache problem you have and/or finding medications which give consistent relief for cluster. It is a technically difficult read for someone not educated in medicine. Its value is in providing case studies about uncommon conditions which appear to be cluster headache but which are, in fact, not.

Broad signs which may signal that the problem being treated is a cluster mimic are: having made a diagnosis of cluster, the standard medications do not work OR they work for an episode or two and then stop being effective. Second, if the diagnostic signs differ in important ways from the standard signs for cluster (and this is a subtle issue which requires a physician with sophistication).

One of the striking findings reported: Cluster can arise from head trauma as long as 30-years after the trauma!

Some conditions which can mimic primary cluster headache:

Infections
     Aspergillus
     Inflammatory disorders
     Wegener's granulomatosis
     Orbital myositis
     Plasmacytoma
     Multiple sclerosis
Head trauma
Vascular abnormalities
     Arterial dissections
     Arteriovenous malformations
Neoplasms
     Pituitary tumors
     Metastases
Other trigeminal autonomic cephalgias: SUNCT syndrome; Paroxysmal hemacrania; Hypnic headache

"Cluster Headache Mimics", Dale M. Carter, M.D.. CURRENT PAIN AND HEADACHE REPORTS, 2004, 8:133-139.
(Take this citation to your public library and they can order a copy of the complete article for you.)
--------------------------------------------------------------------------------