Hello all,

I wanted to consolidate some cluster headache treatment tips I've gathered for the uninsured (or underinsured) and anyone constrained by budget. I haven't seen this info collected in a single place and it pains me to read comments on other sites (like youtube) of people despairing because they lack insurance.

Since I only have experience with the US healthcare system, I'll limit my observations there geographically.

I. Preventatives are dirt cheap
You can have all the prophylactic meds you need for less than $20/month. Here are after-coupon prices I obtained by using the website/public service "GoodRx" (as of April 2013):

• Verapamil: $15.24 @ CVS, 120mg SA, 180 tablets¹
• Prednisone: $4 @Kroger Pharmacy, 20mg, 30 tablets²

II. Abortives: cheap options
Oral sumatriptan is not anyone's first choice abortive, but what if you could have 120 tablets of 25mg sumatriptan for just $43? Well, you can, sort of:

• Sumatriptan generic:  $43.12 @CVS, 100mg, 30 tablets³
• Welding O2: $300ish to acquire a large tank, regulator, rebreather mask, plus $20 per fill (which should abort dozens of attacks)⁴

Prsonally, if money was tight, i'd cut the 100mg sumatriptan tabs into quarters. The instructions vehemently warn against breaking the tabs, but IMHO if it comes down to a choosing either an unmedicated CH vs chancing a broken pill, broken pill's winning every time.

Also, if your headaches are very regular you can pre-empt them by taking the oral imitrex a half hour (for example) before your attack. If you always get hit right after going to sleep, take a pill before going to bed. This can relieve the need for an expensive abortive.

III. Getting the prescription is probably the hardest part
If you can't afford a doctor's appointment, here's what I would recommend:

• 1. educate yourself on CH treatment (bob has posted lots of great links to articles),
• 2. print out those articles and carry them with you,
• 3. make an appointment at a free or low cost charitable clinic (or if worse comes to worse, an ER cannot legally turn you away),
• 4. explain your condition to the doc, show him the hard copies of the CH articles, ask him for prescriptions for prednisone, verapamil, generic sumatriptan at the quantities recommended in the articles.

IV. Learned helplessness is your enemy
I know it sounds ridiculous when you're having a full bore attack, but don't accept the pain of CH if you haven't exhausted every possible remedy. Reject it. Do everything in your power to get away from it.

The tough part is that relief is not something obvious- it will require research, thought, understanding, planning, and execution. This stupid disease affects us all in different ways and does not respond universally to a particular therapy or dosage of meds. Being uninsured during a cycle can make you feel like a tortured, caged animal. You're not. You have inexpensive options I listed above. Fight it, man/woman.


Notes & sources
In case any of you are wondering, 'coupons' from GoodRx are legitimate. It's a privately run public service for the uninsured that was started by a former early facebook employee.

He was alarmed that the uninsured cannot compare prices among pharmacies, so GoodRx negotiates quotes for comparison shoppers ('coupons') in order to introduce competition among the pharmacies. You print out the coupon and give it to the cashier and get a discount (90% in the case of generic sumatriptan), the pharmacy gets new business since the 'full price' is a fake number made up for insurers. Yes, the US healthcare system is a janky mess.

If you don't trust me, here's a 2012 LA Times profile on GoodRx: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

¹Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or
²Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or
³Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or
⁴Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or