Welcome to the board! The verapamil dosing is low for CH, is that primarily for CH or for blood pressure? Verapamil is a common prevent for CH but we go as high as 960 mg a day on it. Topomax is also a common CH prevent.

Have you had a chance to read the oxygen info tab on the left? 32 year episodic sufferer here, I can abort an attack in 6-8 minutes by huffing oxygen. Been a real silver bullet for many people on the board.

The early evening attack is common, often referred to as the "let down" attack. Staying stressed and "up" tends to keep the beast at bay. As soon as you relax, WAM!

You have much reading to do on this board. A well educated CH'er hurts a lot less!

Joe

Helpful to learn some of the basics about Cluster. Explore the buttons, left, starting with the OUCH site. Then these two pieces:

PDF file, below.




Cluster headache.
From: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or (Orphanet Journal of Rare Diseases)
[Easy to read; one of the better overview articles I've seen. Suggest printing the full length article--link, line above--if you are serious about keeping a good medical library on the subject.]

Leroux E, Ducros A.

ABSTRACT: Cluster headache (CH) is a primary headache disease characterized by recurrent short-lasting attacks (15 to 180 minutes) of excruciating unilateral periorbital pain accompanied by ipsilateral autonomic signs (lacrimation, nasal congestion, ptosis, miosis, lid edema, redness of the eye). It affects young adults, predominantly males. Prevalence is estimated at 0.5-1.0/1,000. CH has a circannual and circadian periodicity, attacks being clustered (hence the name) in bouts that can occur during specific months of the year. ALCOHOL IS THE ONLY DIETARY TRIGGER OF CH, STRONG ODORS (MAINLY SOLVENTS AND CIGARETTE SMOKE) AND NAPPING MAY ALSO TRIGGER CH ATTACKS. During bouts, attacks may happen at precise hours, especially during the night. During the attacks, patients tend to be restless. CH may be episodic or chronic, depending on the presence of remission periods. CH IS ASSOCIATED WITH TRIGEMINOVASCULAR ACTIVATION AND NEUROENDOCRINE AND VEGETATIVE DISTURBANCES, HOWEVER, THE PRECISE CAUSATIVE MECHANISMS REMAIN UNKNOWN. Involvement of the hypothalamus (a structure regulating endocrine function and sleep-wake rhythms) has been confirmed, explaining, at least in part, the cyclic aspects of CH. The disease is familial in about 10% of cases. Genetic factors play a role in CH susceptibility, and a causative role has been suggested for the hypocretin receptor gene. Diagnosis is clinical. Differential diagnoses include other primary headache diseases such as migraine, paroxysmal hemicrania and SUNCT syndrome. At present, there is no curative treatment. There are efficient treatments to shorten the painful attacks (acute treatments) and to reduce the number of daily attacks (prophylactic treatments). Acute treatment is based on subcutaneous administration of sumatriptan and high-flow oxygen. Verapamil, lithium, methysergide, prednisone, greater occipital nerve blocks and topiramate may be used for prophylaxis. In refractory cases, deep-brain stimulation of the hypothalamus and greater occipital nerve stimulators have been tried in experimental settings.THE DISEASE COURSE OVER A LIFETIME IS UNPREDICTABLE. Some patients have only one period of attacks, while in others the disease evolves from episodic to chronic form.

PMID: 18651939 [PubMed]

Hello Pete and welcome to the board!

How do you find Topamax? I have just come off of it due to becoming stupidly forgetful and not being able to write without getting my words/letters mixed up! However it was a good med for me as it helped lower the amount of attacks I was getting

Hope you have a good New Year too!

PFDAN x

I'd skip the morphine and use oxygen to abort.

Using the method described with the link on the left I average killing a CH in about 6 minutes without any of the side affects and addiction risks associated with morphine. Plus morphine is unlikely to effectively deal with the pain of a CH.

One more here voting yes for hi flow 100% O2, no on the morphine.

I bet having a nice M tank of O2 to come home to in the evening could be really good for you - especially if there's  no evening beer or other alcohol involved, since that is a trigger for so many of us.

An unfortunate fact about CH and most doctors is that they know little to nothing about it or how to treat it effectively. Good luck finding ANY doctor who will volunteer hi flow 100% hi flow O2 - doctors are pretty universally ingorant on the O2 subject. This is why so many of us weren't getting very effective relief until making it to this site and taking advantage of the info and advice here. Many here just use welding O2 and skip getting a prescription from a doctor.


Peter - have you been episodic or chronic these past 6 years?