I was recently prescribed Inderal (propranolol) as a preventative for CH. I had been taking Topamax for the last year and few months. However a change in insurance meant no more Topamax for me. Even with paperwork from my doctor's stating the medical necessity  of it. The insurer said I had not tried EVERY kind of MIGRAINE prevention. I do not get migraines. Seems no one gets there is a difference. And with Topamax being nearly $400 a month for me it was quite out of the question. I have taken most of what is on the market. Imitrex both spray and pill. The entire triptid family. Paxil, Wellbutrin, Effexor (I know but at the time they new little about 'headaches') and I am sure a few others I have forgotten. I was given Midrin in 1998 at the ER. It worked to lessen the intensity of the pain but I was 'cracked' out for hours if I took 2 and days if I took more. I still have it as a back-up to this day. I went years not knowing what I suffered from. But after a friend pointed out the similarities to his mother's headache, I was able to figure it out. I was prescribed Topamax after talking to my doctor and realizing it was indeed Cluster Headaches I had been suffering from my whole life. We started out light. 25mg/day for 2 weeks. Then twice a day. Then 25mg in the morning and 50mg at night. Then 50mg both. Finally I was at 100mg twice a day for nearly a year. But after losing my job to the economy and having to go on Medicaid I lost the Topamax. Too expensive they said. It isn't a preferred (cheap as hell to us) drug. Endless run around and paperwork to have smoke blown up my ass over and over again. So January 1st, 2009 was my last dose. I was concerned since I had responded so well (from 3-4 CH/day to 1-2/month). And now my security blanket was gone. It took a few weeks for it to catch up but it did. I cycled for about a month. Pain for 16-18 hours with no relief then nothing for about a day then right back into it. It was hell. At one point I was taking Vicodin 750mg 2-3 at a time just to dull the pain enough to see my kids. And that relief was short lived. Not even my old standby Midrin could help me. And I was nervous about taking a new drug as the insurer wanted me on Depakote or Propranolol. I have low blood pressure and a normal heart rate as it is. And I have heard bad things about Depakote. So I went 'commando' for 2 months. The pain was horrible. I had a falling out with my doctor as a result of all this. So I had to find a new one. And we are in the country here. Not exactly a trove of doctors to choose from. I found a new one and she wanted to try the propranolol. I voiced my concerns and she put them at bay. So I am now taking Inderal (propranolol) as a prevention and Fioricet as an abortive. It has been about 5 days and nothing yet. But this really isn't my season to cycle. More random this time of year. Cold sets me off most of the time. Air conditioning can too. But so does dry air. Lose lose lose situation. No matter where I live I get em.  My BP has been lower than normal. As has my pulse (35-45 BPM resting and 60-70 exercising). I have been light headed a lot more and my appetite is insane. I miss the comfort of knowing what I was taking was working. I really didn't mind the weight loss. And the tingling   was tolerable. I now see I may be able to get generic Topamax. I hope my insurance will cover it. But that is what has worked for me. And hot compresses and warm,moist air. Anything cold on my head or face can trigger it. Hence why I sleep in a beany. But thats my story. Hope it can help someone. 8-)

Your doc's lack of knowledge/skill is coming across! I can only hope that he/she is willing to accept treatment information which we can supply you--to give to him. It's a common tactic for many of us.

Urge you to print out both of these documents and give. If you get a snotty response, then time to look for somone new.
====
(Link on line 2)

 
Cluster headache.
From: START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE (Orphanet Journal of Rare Diseases)
[Easy to read; one of the better overview articles I've seen. Suggest printing the full length article if you are serious about keeping a good medical library on the subject.]

Leroux E, Ducros A.

ABSTRACT: Cluster headache (CH) is a primary headache disease characterized by recurrent short-lasting attacks (15 to 180 minutes) of excruciating unilateral periorbital pain accompanied by ipsilateral autonomic signs (lacrimation, nasal congestion, ptosis, miosis, lid edema, redness of the eye). It affects young adults, predominantly males. Prevalence is estimated at 0.5-1.0/1,000. CH has a circannual and circadian periodicity, attacks being clustered (hence the name) in bouts that can occur during specific months of the year. ALCOHOL IS THE ONLY DIETARY TRIGGER OF CH, STRONG ODORS (MAINLY SOLVENTS AND CIGARETTE SMOKE) AND NAPPING MAY ALSO TRIGGER CH ATTACKS. During bouts, attacks may happen at precise hours, especially during the night. During the attacks, patients tend to be restless. CH may be episodic or chronic, depending on the presence of remission periods. CH IS ASSOCIATED WITH TRIGEMINOVASCULAR ACTIVATION AND NEUROENDOCRINE AND VEGETATIVE DISTURBANCES, HOWEVER, THE PRECISE CAUSATIVE MECHANISMS REMAIN UNKNOWN. Involvement of the hypothalamus (a structure regulating endocrine function and sleep-wake rhythms) has been confirmed, explaining, at least in part, the cyclic aspects of CH. The disease is familial in about 10% of cases. Genetic factors play a role in CH susceptibility, and a causative role has been suggested for the hypocretin receptor gene. Diagnosis is clinical. Differential diagnoses include other primary headache diseases such as migraine, paroxysmal hemicrania and SUNCT syndrome. At present, there is no curative treatment. There are efficient treatments to shorten the painful attacks (acute treatments) and to reduce the number of daily attacks (prophylactic treatments). Acute treatment is based on subcutaneous administration of sumatriptan and high-flow oxygen. Verapamil, lithium, methysergide, prednisone, greater occipital nerve blocks and topiramate may be used for prophylaxis. In refractory cases, deep-brain stimulation of the hypothalamus and greater occipital nerve stimulators have been tried in experimental settings.THE DISEASE COURSE OVER A LIFETIME IS UNPREDICTABLE. Some patients have only one period of attacks, while in others the disease evolves from episodic to chronic form.

PMID: 18651939 [PubMed]
==============
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)
================
Michigan Headache & Neurological Institute for another list of treatments and other articles:

START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or END PRINTPAGE
=============

Prop. is only for migraine; decades ago it was tried fof cluster and discarded.
======
If the doc is receptive, print out the info on the first title and give to him. Excellent book aimed at M.D.s.

MANAGEMENT OF HEADACHE AND HEADACHE MEDICATIONS, 2nd ed. Lawrence D. Robbins, M.D.; pub. by Springer. $50 at Amazon.Com.  It covers all types of headache and is primarily focused on medications. While the two chapters on CH total 42-pages, the actual relevant material is longer because of multiple references to material in chapters on migraine, reflecting the overlap in drugs used to treat. I'd suggest reading the chapters on migraine for three reasons: he makes references to CH & medications which are not in the index; there are "clinical pearls" about how to approach the treatment of headache; and, you gain better perspective on the nature of headache, in general, and the complexities of treatment (which need to be considered when we create expectations about what is possible). Finally, women will appreciate & benefit from his running information on hormones/menstrual cycles as they affect headache. Chapter on headache following head trauma, also. Obviously, I'm impressed with Robbins' work (even if the book needs the touch of a good editor!) (Somewhat longer review/content statement at 3/22/00, "Good book....")

HEADACHE HELP, Revised edition, 2000; Lawrence Robbins, M.D., Houghton Mifflin, $15. Written for a nonprofessional audience, it contains almost all the material in the preceding volume but it's much easier reading. Highly recommended.

I did not see you mention oxygen as an abortive.  

You need to find a preventative, that works for you.  BUT, then you need an effective abortive, for those hits that sneak through.  Even if you have tried it in the past, and it did not work for you, read up on the new, more efficient oxygen therapy methods, and try it again.  It is a lot safer and cheaper than any of those other abortives.

See the info, behind the tab, on the left side of your screen: oxygen info

I wish you luck, in finding the preventative that your insurance accepts, and also works for you.  Please look into oxygen as your ace in the hole.

Chuck

And please don't hesitate in the future to divide your writing into paragraphs. My eyes have gone buggy. ;)