Hi, I just want to share some great success I have had with a beta blocker called Bystolic - I am currently taking 5mg twice a day.

First a quick history about me:  Male, 42 years old - suffered episodic CH since age 20.  About two 4 to 6 week episodes per year in my 20's, once a year in my 30's. 

It's been two and a half years since my last cluster, and I really thought I was done with it - but then the beast came back four weeks ago - (possibly because of a very stressful week, ending with a 22 hour work day and bad sleep patterns - by you never really know what the final trigger is for sure  )

I tried a Beta Blocker called Atenolol on my previous episode a couple of years a ago (which was one of the worst ones of my life) and it seemed to have a mildly helpful affect, but I can't be sure because I didn't start it until after the peak, about four weeks in.

This time around I had 10 days of 3 full blown CHs every 4 hours (mostly at night) which I abort with Imitrex - either two full 6ml doses, or broken down to about 4ml using the imitrex tip.

My doctor prescribed Bystolic - which he said was a fairly new Beta Blocker.

This was two weeks into my episode, which usually lasts five or six weeks.

24 hours after taking my first tablet, the CH's stopped.  I did have to deal with a day long headache (about 6/10) which I think was more of a rebound headache from all the imitrex I had been taking.  But after that no more CH. And I didn't need to take any more imitrex.

I have been CH free for two weeks since starting Bystolic.  The best part is having a good night sleep without waking up in agony.  I still feel a mild shadow in the mornings which goes away after an hour or so, but nothing that stops me from getting through my day. 

So far I have had no side effects.  If anything changes, or the CH comes back in the next few weeks, I will update this post.

Anyways, Bystolic seems to have worked for me. So if you are looking for another treatment option, you might want to give it a try.

Bob the Nitrous Oxide effect is curious.
It may be that its in a cellular atachment state vs free flowing nitrous oxide in the blood stream.
I certainly dont know.
Verapamil to my understanding is one of the few Beta or calcium channel blockers that doesnt potentiate NO.
It does appear that the Nebivolol works in a more selective way than verap not blocking as many receptors in a blockade.

"•Nebivolol is a selective beta-1-blocker that also modulates nitric oxide release to produce vasodilation, thereby reducing total peripheral resistance"
Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

"In conclusion, dihydropyridine and benzothiazepine CCBs up-regulated eNOS expression and activity and enhanced NO generation in cultured human coronary artery endothelial cells. However, no such effects were observed with verapamil, which belongs to the phenylalkylamine class of L-type CCBs. The mechanism by which the former CCBs enhance eNOS expression in endothelial cells is presently uncertain and awaits investigation."
Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

Glad its helping you Jon.
Its allways interesting to see a new treatment option.

My heart doctor recently prescribed Metoprolol to smooth an irregular heartbeat and hopes it will also prevent CH (I'm well into a 12 week cycle). Verapamil and prednisone have been the most effective PM's for me so far with caffine/ergotomine as a pain reliever. As beta-blockers (metoprolol) are like a third tier PM vs verapmamil as a first tier, I'm holding off on the Metoprolol until out of my cluster period.

An interesting class of meds for CH! I just looked at PubMed and found only 31 hits dating from 2007 (latest) to the early 1980s on beta blockers for CH.

What this suggests is that there is a high random factor in whether any specific BB works for an equally unpredictable population. I just have this vague memory ref. CH treatments, covering the last 30+ years, of single reports of a new BB for CH and then the name disappears in a few months.

For you young squirts who complain about medicine/docs for CH--we are in a dream land compared to where those who are 60+ had it in their "youth"!

I had episodic clusters that were mostly in the winter at first, then later switched to 4-5 weeks in Spring followed by a brief reprieve and then late June...BAM! nasty bad for 8-12 weeks, up to 7 bads in 24 hours and not just during the night, but at work, etc.  I was put on Bystolic 5 mg daily in the Spring of 2015 and it seemed to reduce my Spring clusters. So 4th of July comes along and all I have is shadows here and there when I expected to be peaking into the nasty zone. Now this Spring I have had a couple shadows and only used Imitrex IM once (probably missed 2 days of bystolic on a trip out of town without meds with me). OK now I'm fully compliant and nothing but a couple shadows since the last Imitrex. If I can make it through the Summer (again) without using Imitrex then I am a believer.  I use to have to take 1200 mg of verapamil per 24 hours to get out of a cluster phase but I got into problems with "Accelerated junctional rhythm" so I had to stop it.  My Imitrex stock pile is growing cuz I get it autoshipped every month and some of it is even going to expire soon and that NEVER happened before.  I would run out of my 'quota' and have to pay cash. Sorry to ramble but if my clusters come back enough to use Imitrex again I will try Bystolic 5 mg twice a day before I do anything else (and hope my heart can handle it). I really don't have an opinion on the nitric oxide angle but I'm curious if anyone knows how mushrooms affect nitric oxide??