Krys,

If you read this post, Bob hit the nail square on the head with his post about the need for neuroimaging for CH'ers having other atypical symptoms to rule out any more serious underlying conditions.  Your husband needs neuroimaging. 

Even the top gun neurologists who can spot a cluster headache sufferer from across the room will follow the accepted protocol and do the neuroimaging.

The American Headache Society recommends the following for patients presenting for the first time with cluster headache symptoms:

1.  Cluster headaches are suffered by more men than women, but short lasting one-sided headache are still most likely cluster headaches even in women.

2.  Correct diagnosis of cluster headaches require awareness of short lasting headaches with red eye, tearing, runny nose and/or other associated symptoms occurring on one side of the head in a series over weeks.

3.  If this is the first Cluster series an MRI with contrast including MRA of carotids and vertebrals is essential.

4.  Control requires both acute and preventative treatments. 100% O2 by mask or injectable sumatriptan or DHE with an early course of steroids and verapamil daily throughout are most effective.

5.  Followup is critical to minimize disability and optimize treatment benefits and safety.

Regarding microvascular decompression question, I'm not a doctor, but  this is a far too drastic and invasive neurosurgical intervention at this point or at any time for that matter given some of the latest developments in treating patients refractory to the standard cluster headache therapies... 

Microvascular decompression is indicated for patients suffering from trigeminal neuralgia (TN) as one of the last options and is only considered when all other medical therapies have proven ineffective in controlling TN pain and neuroimaging indicates possible congenital defects in and around the trigeminal vasculature. 

From what I've read, the potential benefits of microvascular decompression are marginal at best and the potential risks of surgical complications and long-term side effects from this procedure are high.  That puts this procedure right up there with a frontal lobotomy in my book...  but again... I'm not a doctor or neurosurgeon.

The following graphic will give you an idea what's involved with microvascular decompression neurosurgery.

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After cutting an opening in the skull behind the ear, the neurosurgeon will expose the affected trigeminal ganglion, tease the artery next to the trigeminal ganglion away far enough to insert a small telfa gauze or pad to act as a mechanical buffer to keep the artery from compressing against or chaffing the trigeminal ganglion.

hope this helps,

Take care,

V/R, Batch