Akeroid,

Follow Bob's suggestions... particularly in finding a physician experienced in the treatment of patients suffering from cluster headache and other trigeminal autonomic cephalgias. He's spot on!

While you're looking for a good headache specialist, see your PCP for a lab test of your 25(OH)D.  This is a metabolite of vitamin D3 that's used to measure its status. 

The normal reference range for 25(OH)D is 30 to 100 ng/mL.  From the data we've collected from hundreds of CH'ers here at CH.com over the last three years, nearly all were vitamin D3 deficient...  i.e., a 25(OH)D serum concentration less than 30 ng/mL.

If your labs come back indicating a vitamin D3 deficiency, see the following links for an effective course of action in treating that deficiency:

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Regarding Carbamazepine... it's an anti-epileptic/anti-seizure medication with off label use in treating facial nerve pain (trigeminal neuralgia).  It has limited efficacy in preventing CH and it carries the following warning:

"SERIOUS AND SOMETIMES FATAL DERMATOLOGIC REACTIONS, INCLUDING TOXIC EPIDERMAL NECROLYSIS (TEN) AND STEVENS-JOHNSON SYNDROME (SJS), HAVE BEEN REPORTED DURING TREATMENT WITH TEGRETOL. THESE REACTIONS ARE ESTIMATED TO OCCUR IN 1 TO 6 PER 10,000 NEW USERS IN COUNTRIES WITH MAINLY CAUCASIAN POPULATIONS, BUT THE RISK IN SOME ASIAN COUNTRIES IS ESTIMATED TO BE ABOUT 10 TIMES HIGHER. "

See the following links for more details:

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There is a Standards of Care set of recommended treatments for CH developed by a international team of neurologists from the European Federation of Neurological Societies.  These neurologists are recognized for their expertise in treating patients with CH.  Their recommended treatments are illustrated in the following chart:

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You can find more about these treatments at following link: 

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I've had the opportunity to meet one-on-one with three of these neurlogists. Dr. Arne May, Dr. Peter Sandor and Dr. Peter Goadsby. 

All three prescribe oxygen therapy as their first abortive of choice along with a triptan-based nasal spray or SC injection as a bailout/escape abortive.  Abortives are used to stop/abort an attack.

They also prescribe a short duration prednisone taper while titrating up on verapamil as a preventative course of treatment.  All three suggest an ECG before and after starting verapamil to ensure you don't have bradycardia as a result of taking it.

All the above isn't going to do you much good in the mean time.  So here are a few things to try that many of us have done. 

Ice packs to the side of the face or top of the head on the hit side can help dull an an attack. 

I prefer a single ice cube wrapped in a wet paper towel on top of the head just off center on a line even with the front of the ear.  There's usually a tender spot that's not too difficult to locate. The skin will sting a bit for a few minutes but as the cold sensation deepens, you're experience a numbing effect on the CH pain.  If you're worried about your hair, wrap the paper towel and ice cube in some stretch wrap.

Drinking a cold Red Bull at the first indication of an attack works for many CH'ers.  Hyperventilating with room air can also help with CH attacks at the lower pain levels but isn't much help with heavy hitters.

Taking melatonin before bed buys some CH'ers additional pain free sleep.

Check your PM inbox at the upper left of this window.  I've left you some additional information.

Take care and please keep us posted.

V/R, Batch