Pred. for quick relief to be used as a long term preventive is starting to work is standard practive. Use of Indo. has disappeared from common use although it continues to be listed in some medical journals but I can't recall anyone here using it. (It's hard on the stomach in large doses and/or long termuse.)

Verapamil is the most effective and common used preventive. Start at the same time as the Pred so that it can build up in your body as the Pred. is tapered off.

Print the PDF file, below, and use it as a tool to discuss your options.

I hope the Suma. is an injection form. Pill form is to slow for Cluster; nasal injection works but less satisfactory for many folks.

Following is not widely used but is highly effective, has the advantageof a pill, and low cost.
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Headache 2001 Sep;41(8):813-6 

Olanzapine as an Abortive Agent for Cluster Headache.


Rozen TD.
Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. THE INITIAL OLANZAPINE DOSE WAS 5 MG, AND THE DOSE WAS INCREASED TO 10 MG IF THERE WAS NO PAIN RELIEF. THE DOSAGE WAS DECREASED TO 2.5 MG IF THE 5-MG DOSE WAS EFFECTIVE BUT CAUSED ADVERSE EFFECTS. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and TWO PATIENTS BECAME HEADACHE-FREE AFTER TAKING THE DRUG. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. IT ALLEVIATES PAIN QUICKLY AND HAS A CONSISTENT RESPONSE ACROSS MULTIPLE TREATED ATTACKS. IT APPEARS TO WORK IN BOTH EPISODIC AND CHRONIC CLUSTER HEADACHE.

PMID 11576207 PubMed

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Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.
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It will help us to direct you to good sources of assistance if you will tell us where you live (city & state, if U.S. or country). At the Home page: Help button-->Edit & Profile --> Location. (This will add your location, just below your name, every time you post a message.

BTW, Bob, I'm using the injection form of sumatriptan. Used it last night for the first time. Wonderful response in about 5 mins!  In your opinion, how often can I use it before it loses it's effectiveness? Can it be used every night while in episode?

Thank you, Bob!

Speaking only for myself, I don't bother with indomethicin for CH. Certainly it has some small effect but not enough to make it worthwhile.

When you post here it's like the cavalry comes out. Awesome!  My neuro (actually neuro pa) is about to call me to discuss switching to verapamil. I'm going to ask her to start me on 240 mg per day, three times a day, increasing the dosage throughout the day to 80 mg at night before bed for a total of 240 mg per day. This follows the protocol I have seen on here. This has been a whopper of a cycle, and I'm at day 19 or 20. I'm started using the pred at 80 mg today with a taper. Does 240 sound like a enough at this point in my cycle, or should I ask for a stronger initial dose?

BigHitter wrote on Mar 5^th, 2015 at 6:08pm:


Some people will respond at 240mg a day of verapamil, although many need 360-480mg a day and some go to around 1000mg a day! But it is not possible to predict what will work for you and it can even vary between cycles to complicate things.

Start at 240mg and see how it goes. Remember that it takes about 7-10 days for a dose level to become effective, so don't change it too quickly or you'll not know what is effective.

Also get an ECG every few months when on a high verapamil dose as it can impact the PR interval which the ECG will detect.

I'm also convinced that verapamil has concrete dust as an ingredient as it can result in constipation for a while but this normally soon passes (pun intended).

Verapamil worked pretty well for me, although vitamin D3 did even better helping me go CH pain free for over 3 years.

Mind you, we must always remember that indomethicin is a wonderful, wonderful medication used in the treatment of some devastating headache disorders that aren't CH.

I know one poor soul who's been known to sprinkle it on his corn flakes.

I've been on the D3 regimen since Sunday Feb. 28th. Not sure what the impact has been. Over the last 8 years most of my cycles have had moments of real pain, but also moments of pain that were totally manageable, and I even had two cycles that were so benign that they were like a walk in the park. But holy hand grenade, this cycle has been a true monster - 5 a night, one a day.  I've never had such an active, painful cycle.  In fact in the 23 years I've been episodic, I can count the number of times I've missed work on one hand - and that was with no meds. In this cycle I've already missed a full week of work, plus a few days more. Thus the need for pred, verapamil, the D3 and yes, ativan. I'm not making light of the ordeal soldiers went through in Iraq, but I feel like I have PTSD this cycle, so the ativan is being used to just control the nerves.  Thank you again to all of you who lend an ear, suggestions, and encouragement. You people are true heroes to me.