I had one he!! of a CH last night.  I was taking a nap after work and woke up deep into a Kip 9-10.  10 minutes of O2 and only a slight decrease in pain.  2 tylenol 3 and 2 500mg tylenol tried after 15 minutes of minimal oxygen effect.  This will usually kill it.  40 minutes after tylenol and still a K9.  Much oxygen and pacing later, probably about two hours into the headache and still no letting off.

I went into the bathroom and looked in the mirror.  I usually have mild swelling and bulging of the eye on the effected side.  This scared me though.  My right eye was  bulged out at least 3/8-1/2 inches further than the left eye. 

That scared me.  I have never had it that bad.  After that I started slamming coffee.  three cups later the headache finally started to go away.  It lasted in total 3.5 hours.  After that I took 15mg of melatonin and made it all night without interruption from sleep except for peeing out all of that coffee.

Is there a point in which 911 becomes necessary?  That extreme bulging scared me.

The clusters just came back after 14 years absence and they came back worse than I ever remember them being.

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I think your first post here on the "getting to know ya" board was a similar experience. 

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It appears no preventative was started this episode, and oxygen is your only way out.  It can be a hard go even for oxygen when waking to a runaway hit peaking, and this can happen.  What you were looking for was a back up abortive, like Imitrex, which you don't have.

What can work for these times more successfully than oxygen alone, and some here do this, is to keep some Red Bull, Monster or Starbuck's Double Shot in the refrigerator.  If you can immediately get to them and guzzle one, then quickly get on the oxygen, it can REALLLLLY help.   

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The three coffees may have helped, but far after the fact.  Enduring that long, and I know it's hell, could be prevented much sooner. 



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Don't underestimate it's capacity for pain.  Slamming an energy drink at the first moment and hitting the oxygen won't save you any sleep, but getting rid of the pain is an important trade-off.

Hi Eric,
Go get some energy drinks containing Taurine and Caffeine such as Redbull, Monster, Rockstar, etc whatever floats your boat....slam it as fast as you can, no need for anything larger than a typical 8 ounce energy drink can, chug it fast at onset of attack.

The melatonin taken 30 minutes or so before bedtime has also proven helpful to many by reducing their night time attacks and/or reducing the pain intensity of night time attacks.

The o2 is going to be your savior!  It is the least expensive and safest abortive treatment available for CH's.  But it only works if you use it correctly.  It actually can get a little tricky, but with practice and paying attention to the basic rules of o2 use for CH's, you will be very pleased! 

Please help us, help you, by answering the following questions about your o2 use...
1. Do you have a medical prescription for it or are you using welders o2? 
2. What flow rate are you using or are you using a welders regulator? 
3. Are you using a NON-rebreather mask with a large bag attached to it that inflates/deflates as you use the o2? 
4. Are you hyperventilating your o2 ir just breathing normal? 
5. Are you sitting upright/standing or laying down using the o2? 
6. How long do you use the o2 before you turn it off?
7. at what point of your attack do you begin using o2...immediately at onset, after several minutes pf pain or when?

Your answers to these questions about your o2 use will make or break your o2 experience.  Please share your answers and we can better help you achieve fast aborts with o2.

Stay away from the OTC (over the counter) pain relievers and stay away from narcotics.  We know more here than most of the medical community and have learned OTC and pain meds contribute to a worse cycle in many ways.  Just stay away, trust us on this advice!

Do you really want the ambulance arriving with the sirens and lights flashing and your neighbors looking and having to explain to the paramedics what you need to abort your attack, just to be possibly be told..."That is not the way we handle headaches...here Eric, take these two aspirins, call us when you really have an emergency, now go back to bed and get some sleep."  It is truly possible you might be provided such ignorant advice as i'm sure you've learned, most of the medical community doesn't understand CH's. 

Why go through that possible scenario if you don't have to...and you don't have to.  You may feel like you have to call 911 when you are in a high KIP, but you really don't have to. 

Then again, it's your life, call 911 if you really feel the need, but do consider some facts....the cost of money and the cost of time and the cost of aggravation explaining to paramedics/EMTs/hospital employees/neighbors/etc who most likely will not have a clue how to help you...

....compared to the cost of doing it on your own by obtaining the energy drinks, melatonin, some ice packs or frozen peas and all the o2 supplies (tank, regulator and mask)....ideally you get to a good headache specialist and begin preventative treatment ASAP.   We can recommend a good doctor close to you who is familiar with CH's.  Where in Central NY do you live?

Help us, help you, answer some questions and hang tough!  You are certainly not alone here.  We understand your pain and frustrations.

-Gregg in Las Vegas

Eric, you sound serious to help yourself, so please take the following criticism constructively.  You are using o2 incorrectly and that is why you are not as successful as you could be and hopefully will be.

You truly need a NON-rebreather mask.  Order it from the ch.com store-yellow tab on your left side of the screen, ships within 2 days, it's worth it's weight in gold.  With all due respect your rig from 14 years ago is quite impressive, however just not able to compete with a NRB mask with 3 litre bag and 6 ft hose.

Stop holding in your breath, you refer to it as a "hit", and exhaling, then repeating.  You must hyperventilate as fast as you can for as long as you can.  It is tough work, but it is the optimal abort method.  The concept is to rid the co2 buildup which is the culprit causing inflammation of your trigeminal nerve which creates your pain.  Breathe in the o2, breathe out the co2, as deeply as you can inhale, as deeply as you can exhale, as fast as you can, as if you just ran a marathon, as if you are a panting dog in heat, as if you are having an asthma attack, i'm serious, this is truly the fastest and most effective method.  The NON-rebreather mask (with 3 litre bag attached) you will order called an Optimask is designed for this type of hyperventilation.  Don't be alarmed when feeling lightheaded and coughing, this is a common side effect, along with a tingly sensation at your mouth and fingertips.

Good you have welders o2, then you have no prescription challenges of getting as much as you need whenever you want.

Good you have a welders regulator because the high flow rates are required to hyperventilate.  Welders regulators do not have lpm (litres per minute) but don;t be concerned of that, welders regulators will provide a higher flow rate than you can compete with.

Giving up after "15 hits" or so is a major problem.  Remember you are no longer taking hits, you are hyperventilating/breathing as fast as you can, as deeply as you can, inhale as deep as you can, then exhale as deep as you can til the wind is knocked out of your stomach.  Plenty of o2 "how to" threads available on this site...yellow tab on left.  Many can abort an attack with o2 after 5 minutes of effort.  then to avoid a repeat attack and/or rid the potential of a quick co2 buildup...lower the flow rate and breathe normal for an additional 5 or 10 minutes after the abort.  Then live life large between the attacks!

Sitting upright, excellent to read.  Standing and sitting upright are preferred posture during o2 therapy because your lungs are wide open which provides you to maximize your breathing.  On the contrary, laying down and using o2 is counter productive as your lungs are somewhat obstructed in this laying position.  So always hyperventilate standing or sitting upright.

Excellent you recognize the priceless value that you must get on the o2 at onset of attack, the sooner the better.  If you wake up with pain, you are already lacking time and need to move quickly to get that mask to your face and begin hyperventilating.  If you can not get to the o2 before you reach a KIP 5, chances are you will have serious challenges aborting with o2 on that particular attack/attempt of o2 therapy.  The sooner the better!

Do you have a headache doctor from 14 years ago?  Where in Central NY do you live?  I'm going to research NY for you and provide you a list of recommended doctors.  You truly need preventative treatment, as abortive treatments are only the quick fix.  The goal of preventative meds is to reduce the frequency of attacks, minimize the intensity of the attacks and shorten the cycle.  Not all preventatives work.  What worked for somebody last cycle, may not work this cycle, as the beast morphs, it is all trial/error, but you must be knowledgeable moreso than your doctor so you are not prescribed a med and/or a dosage that is known to be worthless.

As for your bulging eye...I personally have never heard of this specific side effect of a CH attack, however you should get it checked out if it continues to concern you.  Hopefully others from this board will chime in with their thoughts of this swelling/bulging eye issue.

Below is a long list of recommended doctors in New York who are familiar with CH's, updated 5-20-2012 from the OUCH website.  Hope this list helps you get into see somebody quickly for preventative treatment.

-Gregg in Las Vegas

"[u]New York[/u]
Bay Shore:
Dr. Norman L. Pflaster South Shore Neurologic Associates

Bronx:
Dr. Randall G. Berliner Regional Neurological Associates
Dr. Seymour Solomon Montefiore Medical Center
Dr. Derek G. Randall

Camillus:
Dr. Kevin W Thomas FamilyCare Medical Group – Neurological Division

Canandaigua:
Dr. Robert S. Knapp Ontario Neurology Associates

Cedarhurst:
Dr. David Steiner Five Towns Neurology

New York:
Dr. Mark W. Green␣ Mount Sinai Center for Headache and Pain Medicine
Dr. Alexander Mauskop New York Headache Center
Dr. Lawrence C. Newman The Headache Institute St. Luke's Hospital

Owego:
Dr. Keith Nichols (PCP)

Rochester:
Dr. Gilbert Proper Pain Symptom Management Center␣
Dr. Joseph I. Mann
Greater Rochester Neurological

Schenectady:
Dr. Bruno P. Tolge Schenectady Neurological Consultants and the Headache Center of Northeastern NY␣

Stony Brook:
Dr. Patrick E. Poole

White Plains:
Dr. Ronald M. Silverman Neurologic Consultants of Westchester

Williamsville:
Dr. Peter R. Kinkel Kinkel Neurologic Center"

Thanks Bill.

Thanks everybody.

  Hopefully I'm not the first to have an eyeball shoot out of my head, lol.

This cycle sucks bad though.  The past week has been five plus per day.  It seems like it won't quit.  Only a few of those were difficult to abort. 

Now if I can only keep the depression, despair, and irritability  tamped down.

Eric

Gregg and Bill both brought up good points.  Each of us have to learn what works best for us on the O2  The key is a high enough flow rate.  I personally prefer the O2ptimask (Gregg referred) with the 3 liter bag with as much O2 as I can get.  I do all I can to hyperventilate, but usually don't reach it although I suck the bag flat at 25 lpm. 

5hr Energy is a preference of mine also because I can get it all down so much more quickly than the others and I don't have to taste as much of it.   (not quite that bad, but...)  It is also very handy to carry with you so you don't get caught without any ammunition when out in public.  I carry at least one in each of my vehicles, one in my computer bag, and one in my pocket.  I hate getting caught out when I have forgotten to replace an empty in my pocket!

As to the eye bulge, I don't believe you have anything to worry about, but it should be checked out by your Eye Doc just to be certain there is nothing else going on.  Mine bulges also, but my doc has not found any permanent damage.  That brings up a different matter though all together.  When was your last MRI/MRA?  You said it has been 14 yrs.   I strongly suggest you be seen post haste to be certain there is not something CH like in symptom that is much worse.  It most likely is not, but I'd rather have you spend the money on checking it out and find nothing wrong than on a casket because it was not checked.   

All the best,
Jerry