Hey Mark,
Thank you for your Service... Suffering from cluster headache or migraine is bad enough. Suffering from both and getting hit by both at the same time is a real bummer.
It sounds like you're seeing an understanding and trained neurologist given the ready supply of oxygen and triptans. Is he or she at the VA?
No matter... I suggest you see your PCP or neurologist, whoever is most familiar with your medical history, for a lab test for 25-Hydroxyvitamin D, a.k.a. 25(OH)D. This is the serum level metabolite of vitamin D3 that's used to measure its status.
I suspect you are vitamin D3 deficient and that deficiency is contributing to both your cluster headache and migraine disorders.
I realize this might sound like an off the wall statement... but as a fellow vet, I don't take this topic lightly, nor do I pass out bum gouge.
The normal reference range for this lab test is 32 to 100 ng/mL. A 25(OH)D serum concentration 20 to 31 ng/mL is an indication of insufficient vitamin D3 and a serum concentration less than 20 ng/mL is clearly vitamin D3 deficient.
What we've found over the last two years is CH'ers with active bouts of cluster headaches who have gone in for this lab test, have had their results come back less than 30 ng/mL.
The exciting news is 80% of more than 300 CH'ers who started the anti-inflammatory regimen with at least 10,000 IU/day vitamin D3 have experienced a significant reduction in the frequency, severity and duration of their cluster headaches... 78% experienced a pain free response, and 60% of the 300 have remained pain free.
Of the CH'ers who responded to the anti-inflammatory regimen with vitamin D3 and then had the lab test for 25(OH)D, all had their results come back in a range from 60 ng/mL to 110 ng/mL.
I suspect you might be waiting for the other shoe to drop... Well, here it is... Migrainerus respond to this regimen as well. Although the numbers of migraineurs who have started this regimen is small, at 15, their response has been nearly 100% with either a significant reduction in the frequency of their migraine headaches or they've gone pain free.
My wife was a chronic migraineur for over 20 years. She started the anti-inflammatory regimen in December of 2010 after seeing me go pain free after 17 years living with cluster headaches haunting me, and the last five as a card carrying chronic CH'er.
Since then she hasn't had a single migraine headache. There are two boxes of imitrex nasal spray applicators in the medicine cabinet that have stayed there untouched for over two years.
The bottom line is you need to see your PCP or neurologist and ask for the lab test for 25(OH)D. If your results come back less than 30 ng/mL, talk to your PCP or neurologist about starting vitamin D3 therapy...
If your results come back greater than 50 ng/mL, PM me your address and I'll send you a bottle of your favorite libation.
The best information on the anti-inflammatory regimen can be found at the following links. The first will provide a complete list of the supplements used in this regimen, dosing, dosing strategies, drug interactions and contraindications. The second link will take you to a forum where CH'ers post their experience with this regimen.
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Take care,
V/R, Batch