I'm now on 720mg Verapamil, and it seems to have helped but I now get bad shadows/mild headaches (when does one become the other?) maybe kip 3/4 morning and evening. A combination of paracetamol and ibuprofen works, but now think the ibuprofen is starting to upset my gut.

My doc is very good, she obviously doesn't have much experience of CH, but she is prepared to accept suggestions. Any advice on a more appropriate, and preferably faster-acting, painkiller for a relatively mild condition?

N

I would advise you to try drugs from the oxicam -family, e.g. meloxicam. They are long-acting painkillers, so you would need only one per 20 hours or so.

Also get a stomach-protection drug along with that, for example pantoprazole.

Incidentally, I got around 10 days of pain-free time after beginning taking meloxicam. The normal CH drugs didn't work.

- Best regards and PFDAN,
Rosa

For those attempted hits that just want to shadow and not break through, an icepack to the temple has helped me get them down.  Sometimes they can be too weak to fight the cold and it can suck the life out of them, unless it's going to persist and strengthen, then add oxygen.
 Only if the pattern has been for them to not break through, otherwise it's best to go to the oxygen first.  In combination with an icepack can speed things along sometimes with its diminishing.  

Hi Niel and welcome. Painkillers do not work on Ch's. By the time the pain killers start to work the CH usually has susided, making us think the pain meds worked. This has fooled me many times in the past before I knew what was going on with my head.

Ask your doc if she is willing to script you o2. If not, time to search out a doc that knows more about CH's.

You will need:
100% oxygen with at least a 15 LPM regulator with a non-rebreather mask, no outside air what so ever, Get on it at the very first sign of an on-coming hit. The o2 takes care of those persistent shadows and low end hits as well.

As a preventative, I take Verapamil at 480mg daily, but that has to be your docs call. There are many prevents available, just have to find what works for you.

Hope this helps in some way,  Barry :)

Barry_sword,

I know that painkillers are generally not considered to work on CHs, but my symptoms were indistinguishable from a regular med-resistant chronic CH by a neurologist specializing in headaches.

The fact is that they work for me. I've been pain-free for months by taking one 90mg pill of Arcoxia per day.

Another doctor, specializing in neurosurgery and CH, said that only a very small fraction of cases is published and makes it into medical literature. My case would have been worth publishing but for some reason wasn't.

- Best regards and PFDAN,
Rosa

I have to agree- some painkillers work pretty good for me, too.  I'm resistant to the usual meds,  but I've found that fioricet and amitryptaline work well for the bigger attacks (although they make me a bit drowsy) and for the smaller beastlets I use Anaprox.  Good luck!

Contrary to what has been posted here, meloxicam is NOT a pain killer.  It is an NSAID, or anti-inflammatory (non-steroidal antiinflammatory drug).  Yes, it is used to treat pain, but by pharmaceutical definition, it is not a painkiller.  As with most NSAIDs, it can be harsh on the stomach.

I suggest that you print out both of this articles and share with your doctor. They represent the most current thinking on the medical treatment of CH.

The use of any pain medication carries the risk of rebound headaches if used too often. The broad rule in the U.S. is 3x or more a week increases the risk.
==================

HERE ARE TWO MAJOR DOCUMENTS WITH RECOMMENDED TREATMENTS FOR CLUSTER HEADACHE, ONE FROM A U.S. PHYSICIAN, THE SECOND FROM EUROPE.
_________________________________________
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE
Here is a link to read and print and take to your doctor.  It describes preventive, transitional, abortive and surgical treatments for CH. Written by one of the better headache docs in the U.S.  (2002. Rozen)
================
Treatment guidelines from Europe

------
A. May, M. Leone, J. Áfra, M. Linde, P. S. Sándor, S. Evers, P. J. Goadsby:
EFNS guidelines on the treatment of cluster headache and other
trigeminalautonomic cephalalgias.
European Journal of Neurology. 2006; 13: 1066–1077.

Download free full text:
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE
(Thanks to "cluster" for link.)

deltadarlin wrote on Jan 20^th, 2009 at 8:41am:

Contrary to what has been posted here, meloxicam is NOT a pain killer.  It is an NSAID, or anti-inflammatory (non-steroidal antiinflammatory drug).  Yes, it is used to treat pain, but by pharmaceutical definition, it is not a painkiller.  As with most NSAIDs, it can be harsh on the stomach.

NSAID's are analgesics (painkillers).  They are not narcotics, but they are painkillers. Sometimes referred to as NSAIA's for "Non-Steroidal Anti-Inflammatory/Analgesic".

Regards,
Jim

For me, any painkiller causes rebounds from Hell, so I do not recommend any of them.

Quote:

Hi Niel and welcome. Painkillers do not work on Ch's.

Well said Barry. Get some 02 you will be glad you did. Knock that shadow right to the curb.
all the best
the bb

I had CH for 28 years and pain killers didn't do anything to help me either.  Just gave me a stomach ache.

Pain killers help me with the non head pain but never has touched the headaches for me.

I had tried Vicodin and Percocet in the past.

Thanks everyone for your replies.
I’d like to say, the paracetamol/ibuprofen combination definitely DOES work (for me), though it seems to leave a ‘space’ where the pain was.  Does that make sense to anyone?
N

Hi Neil, sorry I spelled your name wrong in my first reply.
If you are getting relief with your combo of meds then that is great. They do not work for me so I will stay with my o2 and my prevent.

You should ask your doc about some o2, you might be pleasantly surprise with it's effectiveness on aborting CH's, with no side effects!

PF wishes to you.

  Barry :)

deltadarlin wrote on Jan 20^th, 2009 at 8:41am:

Contrary to what has been posted here, meloxicam is NOT a pain killer.  It is an NSAID, or anti-inflammatory (non-steroidal antiinflammatory drug).  Yes, it is used to treat pain, but by pharmaceutical definition, it is not a painkiller.  As with most NSAIDs, it can be harsh on the stomach.

This is specifically a COX-2 inhibitor.  O2 and ice packs are probably the most effective and least harmful to you on a regular basis.  Some might add an energy drink with 1000 mg of Taurine and 80 mg or so of caffiene.  Personally, if I have persistent shadows, I have an Rx for 800 mg of Ibuprophen that I take with coffee and a piece of bread, as it can raise heck with your stomach.

I hope this helps,

Ray

Some of my episodes have started with a dull top of the head headache which has been continuous for about 4 to 6 weeks. Ibruprofen and Paracetamol alleviated this and when they were around co-proxamol worked well too. When the clusters really start though these drugs don't do anything.

Ellick

The oxygen is your best bet. Even if the ibuprofen and tylenol are working for you, I highly reccomend you get it.

Things can change over time, on top of that, the oxygen won't upset your stomach! An alternative if they bother you stomach too much would be to see if your doctor can give you something to coat the stomach.

Pain killers do work for some people with cluster headaches, but still, oxygen is the best choice.

For the oxygen you'll need 15 to 25 liters per minute, with a non-rebreather mask. If you don't have those two things, it's not gonna work that well for you.

Good luck, and PFDAN
Mystina

I just want to say that it's important to look at the long half-life of the painkiller in question. Ibuprofen for me did nothing. But meloxicam / etoricoxib = total relief.

With a half-life of 20-30 hours of those drugs versus the 2-3 hour half-life of ibuprofen, those drugs are still in effect when the next attack comes. Not so with ibuprofen.

Also, for me the opiates / similar analgesics did nothing. The key was to have COX-2 inhibitors. I'm pretty sure that other oxicams or coxibs would work just as good.

Also for me, it's FAR easier to just take one pill per day instead of messing up with oxygen tanks. Especially so when the oxygen didn't really ever help much. And I -DID- use it tens of times, at 15-25 liters flow speed, through a properly set up right kind of mask.

I haven't got any rebound headaches from meloxicam / etoricoxib either. Etoricoxib is not hard on stomach, as it is a very specific COX-2 inhibitor. The stomach-problems are caused by also inhibiting COX-1. According to the neurosurgeon, it can still be difficult for the bowels, but so far I haven't got any kind of problems.

- Best regards and PFDAN,
Rosa

Neil I am on a lower dose of Verapamil now and also have painful shadows for most of the day. It took about a week on the Verapamil for the shadows to subside. But my doc increased the dose and shortly after, about 1-2 a week the shadows persist. I use an ice pack and pressure and if they start to intensify a combination of ibuprofren (liquid gels) and tylenol (fast-release) help to cut down the pain considerably but not relieve it.  Hope this helps.

Neil, I second, third, fourth and however many more the oxygen recommendations. Over here with our ridiculous medical insurance situations many of us have gone to welder's oxygen for financial reasons. Either way, why not give it a shot and let us know how it works for you!

PFDAN
David

Thanks everyone.
Like I said, with the dose of verapamil I am on now, the pain is at worst only about a 3/4, so I don't think it warrants the inconvenience (and alarm it would cause others) to get oxygen.  
But I do like the sound of meloxicam, I’ll suggest it to my doc.

N

I don't understand what inconvenience and alarm that O2 causes.  It is safe, relatively cheap, and very effective (% wise).  Honestly, Id stay on the verap but try O2 (correctly) as the FIRST line of abortive.

I am somewhat surprised that meloxicam works for people but then again, I should never be surprised with the beast.

If I were you Id see if your doctor has imitrex inj samples you could try AFTER O2.

Just my friendly 2 cents.

NeilB wrote on Jan 23^rd, 2009 at 5:22am:

Thanks everyone. Like I said, with the dose of verapamil I am on now, the pain is at worst only about a 3/4, so I don't think it warrants the inconvenience (and alarm it would cause others) to get oxygen.   But I do like the sound of meloxicam, I’ll suggest it to my doc. N

Just take a pill if ya just got a headache, works every time.

                Kinder gentler Potter

If I'm getting hit, worrying about what others might think of an O2 tank is the VERY LAST thing on my mind.  Seeing me in the throws of a bad one is a whole lot more upsetting than an oxygen tank.

I understand that others may not be the same, but I guess I'm just a big baby when I hit K9+

Respectfully,

Marc

I wonder if I have the same headaches. I have tried all that. None of it even touched anything. Shadow or K 10. It's like a band-aid on a bullet wound. By the time they worked ,if they worked, I would be thrashing and putting holes in the wall with my forehead.
What a deal. Guess I'm a puss.
all the best
the bb

wrote on Jan 23^rd, 2009 at 1:52pm:

I wonder if I have the same headaches. I have tried all that. None of it even touched anything. Shadow or K 10. It's like a band-aid on a bullet wound. By the time they worked ,if they worked, I would be thrashing and putting holes in the wall with my forehead. What a deal. Guess I'm a puss. all the best the bb

   Buck up.

      Kinder gentler Potter

The 15mg of meloxicam, taken every day, for me prevented the attacks. It didn't make an ongoing attack disappear. However, the attacks started to come back after around 10 days, despite taking the meloxicam. Meaning that I got first one attack, then the normal two per day.

I changed it to Arcoxia, the attacks stopped completely. Again, I didn't take it mid-attack - rather, it just prevented (and still prevents) the attacks coming at all. I've been on 90mg of Arcoxia per day since 4.11.2008 and also totally pain-free since that day.

Etoricoxib is a more specific and stronger COX-2 inhibitor than meloxicam is, to add.

I strongly believe that CH is an umbrella term for similar symptoms caused by a variety of medical disorders involving the trigeminal nerve. That is the reason why people find help from different drugs. My disorder, in my opinion, involves an inflammation around that region and the COX-2 inhibitors are the strongest drugs along with steroids to treat it. The doctors couldn't see inflammation from my MRI-images, but the doctors are not omniscient and the MRI is not perfect. The fact is that I'm living a normal life because of a drug that specifically targets inflammation.

Think of it in a way that you might not see because of a variety of reasons too. Some people have had the eyes removed, some have been born without eyes, some are blind because of other condition or disease and some have blindfolds on. Yet the effect remains the same. Some of these conditions are impossible to treat (yet), but some of them are treatable.

- Best regards and PFDAN,
Rosa

NeilB wrote on Jan 20^th, 2009 at 5:15am:

Any advice on a more appropriate, and preferably faster-acting, painkiller for a relatively mild condition? N

12 hour Aleve works well on occasion (naproxyn sodium) otc.