Nigel,

I hate to burst your bubble about being out of cycle, but shadows are headaches...  Out of cycle means pain free.

Even shadows should be dispatched with oxygen therapy ASAP.  The rationale for doing this is based on the accepted fact that CH pain is clearly associated with vasodilation.  There are also other factors in the pathophysiology of CH attacks, but most hold that vasodilation is a fundamental part of that pathophysiology.

That being so, walking around with a "shadow" means you're likely also walking around with partially dilated arteries and capillaries and/or inflamed trigeminal nerve bundles.  Allowing this to continue only results in these arteries and capillaries becoming more flaccid with loss of vascular tone...  and to my way of thinking, that's only going to result in heavier and more frequent hits as the loss of vascular toning makes these vascular structures more susceptible to the CH triggering mechanism when the cycle returns.

IMHO, rogue hits and shadows are a possible indication of a low arterial pH that also results in vasodilation.  A diet high in alkaline forming and anti-inflammatory foods might help.  The following links may help in developing an alkaline forming anti-inflammatory diet that maximizes the good stuff and eliminates the bad stuff:

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The next two links cover anti-inflammatory foods:

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Hope this helps.

Take care,

V/R, Batch

Nigel,

I'm far from being the oldest CH'er or longest sufferer, but from what I've experienced, the only thing consistent or predictable about CH is its inconsistency and unpredictability. 

I can't count the times we've driven off for a day visiting with friends not taking any oxygen or imitrex nasal spray along because I was in a low cycle with just a few hits a week while sleeping... only to be nailed with a heavy hitting head banger during an early dinner.

There's some compelling evidence on some of the factors involved that increase the tendency to get hit more while sleeping.  The simple reasons are we breathe less and our heart beats slower.  As a result, the brain receives less oxygen and CO2 levels climb.  Moreover, both of these respiratory conditions are well known as vasodilators.

Trying to nail down the leading mechanisms that affect the frequency and intensity of cluster headaches the most is like throwing darts a long list homeostatic processes that include oxygen-CO2 exchange, arterial pH balance, body temperature, respiration rates, heart beat, hormones and enzymes.  They all play a role at one point or another in the pathophysiology of the cluster headache and the abort mechanisms.

I bounced the following chart in front of several neurologists at the IHC 2009 14th International Headache Congress in Philadelphia last September and all agreed the three factors presented played a key role in vasoactivity as it applies to the cluster headache.

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As you can see, when we're sleeping, we have three of these values in the red...  And yes, body clock functions clearly play a role.  My guess is that's where the unpredictability comes in.

Take care,

V/R, Batch