My name's Matt and I've been suffering from these headaches since 1997.  32 years old now.

The headaches come on average once per 18 months.  I've had them in all seasons, they were at their most consistent coming every summer while I was in grad school.

The pain is always focused on my right temple, radiating outward.  My eye and nose will sometimes water.  Pressing on and around the temple provides enough relief that I do it constantly during a headache - but not nearly enough to be happy.

The pain will vary.  There's sometimes when I can actually get some work done (analytical stuff), other times it's bad enough I moan and rock and really can't maintain much beyond a very brief conversation.  I will say I don't think I get it as bad as some people - I've experienced "10" level pain with unrelated stuff for a few seconds where I'm literally not self-aware of anything but pain - thank goodness my headaches don't get to that point.

I get lesser pain in the same area immediately preceding the headaches.  Sounds like the "shadows" others on here describe.  I also get this minor pain sometimes not in a cluster - and sometimes during a cluster the minor pain will just kind of stick around, not turning into a full headache, but still capable of ruining the day.

I have TMJ.  Doctors I've seen tend to think that that's related to the headaches.  The last neurologist I saw said my headaches had some characteristics of migranes in addition to clusters, and said it wasn't that clear cut the difference between them.

My lone medication since about 2004 has been Zomig.  It's worked well enough for me that until this past week, I've considered the problem under control.  I had tried Immitrex, made my arm tingle, didn't like that so much, though it also seemed to help with the headaches.  Prior to that I doused myself with Excedrin Migrane, which I didn't realize wasn't doing anything at all until finding stuff that actually worked.

My headaches have typically started with a week or so of 1 or 2 headaches every day, become less and less common and then disappearing after a total of 3-6 weeks.  Headaches typically last 1-2 hours.

A cluster started 2 weeks ago and was behaving normally - then I went a music festival in the desert, followed by getting a cold.  From the last day of the festival through this last week, I've been getting 4-6 headaches a day.  This has meant having to go through some headaches without medication - and yesterday a headache went 4 hr at full strength before I ended up taking a pill.

I am worried about the headaches now in a way I haven't been before.  I was recently laid off (and stress is probably part of the reason the cluster is happening), and I'm wondering how I would explain what's happening to my boss if I were still working.  To say nothing of concerns over whether this is a sign of things to come - or if it might get even worse over upcoming years.

To deal with the amount of headaches I've started cutting up pills.  The pills are 5mg.  The 2.5mg half-pills seem to work fine if I take them early enough, but I seem to have even less lead times than I do with 5mgs.

Currently trying a 1.25mg quarter-pill, to see how that will work.

I have an appointment next Thursday with a neurologist.  Until then, having read on these boards, going to start trying some melatonin and some energy drinks.

Now I have been reading the boards here, but any direct insight would be greatly appreciated:

-Dangers of taking way more Zomig over a month than they say too?  (Been doing this for years, but have never felt great about it)

-Dangers of taking more than 10mg Zomig in a day?  Never done this before this cycle.  This time I've gone up to 12.5mg a few times.  If the quarter-pills work, this won't be an issue any more.

-Danger of simply taking Zomig too often even at a very small quantity?

-Any concerns with taking Zomig, melatonin, energy drinks together?

Thank you so much for your time,
Matt

Yeah definitely.

Oxygen has always sounded like THE thing to use if the situation was bad enough.  First thing I'll ask the doctor about.

Hadn't heard of the nasal spray until this recent mad search through the internet.  Sounds great!

Thanks Bill!

Hi Matt,

A common cold is regularly cited as a trigger event for the onset of an episode or the aggravation of an existing one.

Given that you have seemingly only been using Zomig pills in the past I believe that you need to concern yourself with the fact that you are only employing one single abortive to manage your condition (and with that not the most effective one).

Subject to your existing TMJ condition my advice would be to discuss a suitable preventative treatment with your doctor. This will render Zomig as the secondary abortive it should be, for many here are likely to concur that O2 and not Zomig is the abortive of choice. You may also find that injections or nasal sprays are superior to the pill form, given that they often only start to show effect when the attack is nearing its end.

There is some evidence to suggest that Zomig overuse may (though doesn't have to) cause rebound headaches.

In regards to dosages, several clinical trials seem to support that the 5 mg formula is not more effective than the 2.5 mg one, whereas less people achieved relief from dosages below 2.5 mg.

O2 at 15 lpm or more is likely to abort your attack significantly faster than any Zomig pill, without any of the risks associated with overuse and I suggest that you make this, as well as a suitable preventative medication part of your discussion during your upcoming neurologist appointment.

Below is an excerpt from one of Bob Johnson's previous posts on triptan safety for your reference.

************

Headache. 2004 May;44(5):414-25.Related Articles, Links
Consensus statement: cardiovascular safety profile of triptans (5-HT agonists) in the acute treatment of migraine.

Dodick D, Lipton RB, Martin V, Papademetriou V, Rosamond W, MaassenVanDenBrink A, Loutfi H, Welch KM, Goadsby PJ, Hahn S, Hutchinson S, Matchar D, Silberstein S, Smith TR, Purdy RA, Saiers J; Triptan Cardiovascular Safety Expert Panel.

Department of Neurology, Mayo Clinic Scottsdale, AZ 85259, USA.

BACKGROUND: Health care providers frequently cite concerns about cardiovascular safety of the triptans as a barrier to their use. In 2002, the American Headache Society convened the Triptan Cardiovascular Safety Expert Panel to evaluate the evidence on triptan-associated cardiovascular risk and to formulate consensus recommendations for making informed decisions for their use in patients with migraine. OBJECTIVE: To summarize the evidence reviewed by the Triptan Cardiovascular Safety Expert Panel and their recommendations for the use of triptans in clinical practice. PARTICIPANTS: The Triptan Cardiovascular Safety Expert Panel was composed of a multidisciplinary group of experts in neurology, primary care, cardiology, pharmacology, women's health, and epidemiology. EVIDENCE AND CONSENSUS PROCESS: An exhaustive search of the relevant published literature was reviewed by each panel member in preparation for an open roundtable meeting. Pertinent issues (eg, cardiovascular pharmacology of triptans, epidemiology of cardiovascular disease, cardiovascular risk assessment, migraine) were presented as a prelude to group discussion and formulation of consensus conclusions and recommendations. Follow-up meetings were held by telephone. CONCLUSIONS: (1) Most of the data on triptans are derived from patients without known coronary artery disease. (2) Chest symptoms occurring during use of triptans are generally nonserious and are not explained by ischemia. (3) The incidence of serious cardiovascular events with triptans in both clinical trials and clinical practice appears to be extremely low. (4) The cardiovascular risk-benefit profile of triptans favors their use in the absence of contraindications.

Publication Types:
Consensus Development Conference
Research Support, Non-U.S. Gov't
Review

PMID: 15147249 [PubMed - indexed for MEDLINE]

Brew wrote on Apr 24^th, 2010 at 10:55pm:

   WHAT BREW SAID ONLY REAL LOUD.

            Potter

Hi Matt...

I found that energy drinks help a lot!! the moment you feel it coming just drink one can right away...
I also find that hot compresses very helpful but its individual..

Welcome aboard and sorry to hear that you have the beast

HI matt,

Welcome, i'm a newbie to the forum also. However been suffering with what up until recently has been diagnosed as non specific migraines. Last month i ended up in the hospital. one CT and one MRI later and finally the problem was found. Cluster Headaches. They gave me o2 and verap. i was already on imitrex and lortabs for the original diag.

I just want to say that i agree with my fellow CHrs, o2 is my best friend. If I catch it as it begins with o2 it goes almost completely away, if i use it during it makes the pain more tolerable. either way it makes me feel better, and with our condition every little bit counts.

thx brew, no it was not the mri or ct that found the ch. it actually was the treatment methods that ultimately made the drs realize what was going on.

sorry if my last message was misleading to this fact. they actually did those test because for some odd reason they thought i was having a stroke...even though i didnt have any stroke symptoms,....well other than pain

agreed. better to be sake than sorry

I wanted to give an update.

I started a new cluster this May, a little over a year after my last cluster began. However, this time I took melatonin from the beginning.

I feel so fortunate to be able to say that it looks like I've now made it through an entire cluster without using a heavy duty medication like Zomig. The melatonin definitely doesn't stop the clusters, but I can live with them now.

I know we're all different, and not everyone will be as lucky as me, but if you have not tried taking melatonin during your cluster, I would urge you to give it a shot.

Quote: "I have TMJ.  Doctors I've seen tend to think that that's related to the headaches."

No, it's not. Correcting the TMJ will only do one thing, correct the TMJ. It will not change the cluster headaches.