For those that don't know.  The Clusters had been gone for me for over ten years at least.  I can't remember specifically how long, but the last record my doctor had was from 1998.

Has anyone else here ever had a CH last 44 hours?

It started Friday at around 7:00pm and didn't end until Sunday around 3:00pm.  I would knock it down with red bull, coffee, or a five hour energy, and of course a lot of oxygen for each hit, but on average it would come back every two to three hours.  Closer to two hours though.  That includes the nearly 30 minutes to knock it down.  Even at night.  Several 1.5 hour naps is what qualified for sleep this past weekend.  It never really felt like it went away.  I still had that pressure feeling behind the eye with minimal pain in-between attacks.

That was the first time I found myself brewing up a pot of coffee at 4:00am.

I never had that back when I used to get these.  I would get maybe two to three a day with pain free breaks in between.  Three a day was really bad.  I lost count but I think in the 24 hours that was saturday I went over 10 headaches.

Also, ever since this cycle kicked in with a vengeance, no for-warning, I have had pain on the top of my skull.  it is sensitive to the touch.  It feels like I got whacked on the head with a board.  This goes away if I can go a few hours without a headache.

My theory is that the  CH's spent that long vacation studying new and more painful ways to piss me off.

I am going to try to get an appointment with a local doctor who's name LasVegas posted up. (Thanx Greg) They were closed today though.

Way back then, I did have success the first cycle that I tried the prednisone taper, but the next cycle when I tried it, It didn't help at all.  I think the beasty learned how to beat it.  I'm going to try that again, Hopefully it forgot how to handle pred this time around. I'll get on the Verapamil to kill this cycle once the pred kicks in.  This cycle is completely unbearable.  I've already killed four headaches today with the caffeine/taurine/oxygen fix.  How long is it going to take these headaches to find a way around that treatment??!!

How high of a pred dose should I start on??  I saw mentioned here by someone a 80-0mg taper over two weeks.  I'd rather start really high to not take any chances.  Overkill it.

Thanks again folks for all of your support.

I used 80 mg on my tapers, the high end I've seen posted here has been 100 mg, but I've never seen any "studies" about it.

I'd strongly suggest you go to the medications board and check out the post "123 pain free days and I think I know why" A simple vitamin/anti inflammatory regimen that's providing relief for many. Got me thru a bitch of a high cycle my last go round when even oxygen was failing me. Cheap, good for you even without CH, worth a look see.

As to a 44 hour CH, no that would kill any man! But a 4 day slug fest with constant hits? Yeah,  :'( never happened to me but many on the board have been down that road.

Hit CVS or Walgrens and grab some melatonin, take 9 mg about 30 minutes before you go to bed. Many can reduce or even avoid the night time hits. 9 mg is a starting dose with some going 15-18 mg to get through the night.

Joe

What you describe fits me well... only 1-2 hour breaks and right back at it... for days. The pred is worth a try, but it is all too common for it to stop working like you describe. My tapers were 80mg starting dose, don't use it anymore though.
Good luck with the doc, hope you can wrangle the beast in with the pred and verap. If looking for alternative treatments, check out clusterbusters.com

That happened to me last week

Eric in Central NY wrote on Oct 8^th, 2012 at 7:30pm:

it would come back every two to three hours.  Closer to two hours though.  Hopefully it forgot how to handle pred this time around. I'll get on the Verapamil to kill this cycle once the pred kicks in.  How high of a pred dose should I start on??

I had the same happening at night, within 2 hours, right back four to five times in a row, this was about a week ago, too.  A higher time of activity.  Being on a low dosage preventative already, I had the verapamil upped adding another 120mg, which brought it to an end.

When originally starting with pred and verap, 100mg pred was tapered down over a twenty day period, which by then had the verapamil gradually increased to where I was just starting 480mg/day in about three weeks.  The slower rate allows stepping up the verap in 80mg increments, which I found suits me best.

Some will start predisone at 60 or 80mg in a shorter descending taper, but I like the longer time to get the verapamil working by the time pred ends.  Even with that longer taper, I still had to continue to increase the verap to 640mg until things subsided.

Being chronic, I maintain a low dose of verapamil year round, otherwise hits can be sporadic and consistent, anywhere anytime, the verap keeps that at bay,  There are times of higher activity.  It's usually been just a short stepping-up to remedying them quickly.  I test the waters to lower the verap again after awhile, even tapered down to nothing, once.

The doc visit could help. 

Two clues that need exploration: the 44-hr attack suggests not Cluster; standard Cluster meds which work for a 1-2 attacks and then stop being effective also points to a non-Cluster issue.

See: 
Link to: cluster-LIKE headache.


Section, "Medications, Treatments, Therapies --> "Important Topics" --> "Cluster-LIKE headache"
======

Clearly need a headache specialist who has skills to sort thru this complex set of potentials.

You could be suffering from rebound headaches from the taurine/caffeine combo. I had a headache that seemed to last for an entire day, and it wasn't until I forced myself to go cold-turkey on the caffeine that the long headaches went away. I would recommend the energy drinks only when you are at work and absolutely have to be on your game.

Reading you original message I was struck by the fact that you are using secondary/OTC treatments vs. the standard package which is, generallly, the most effective.

Pred: Start at 80-100mg BUT,

Also start Verap at the same time you start the Pred. Takes time for it to become effective (plus possibility for dose adustments). Pred for instant response, Verap for the long haul.
-----
Headache. 2004 Nov;44(10):1013-8.   


Individualizing treatment with verapamil for cluster headache patients.

Blau JN, Engel HO.


    Background.-Verapamil is currently the best available prophylactic drug for patients experiencing cluster headaches (CHs). Published papers usually state 240 to 480 mg taken in three divided doses give good results, ranging from 50% to 80%; others mention higher doses-720, even 1200 mg per day. In clinical practice we found we needed to adapt dosage to individual's time of attacks, in particular giving higher doses before going to bed to suppress severe nocturnal episodes. A few only required 120 mg daily. We therefore evolved a scheme for steady and progressive drug increase until satisfactory control had been achieved. Objective.-To find the minimum dose of verapamil required to prevent episodic and chronic cluster headaches by supervising each individual and adjusting the dosage accordingly. Methods.-Consecutive patients with episodic or chronic CH (satisfying International Headache Society (IHS) criteria) were started on verapamil 40 mg in the morning, 80 mg early afternoon, and 80 mg before going to bed. Patients kept a diary of all attacks, recording times of onset, duration, and severity. They were advised, verbally and in writing, to add 40 mg verapamil on alternate days, depending on their attack timing: with nocturnal episodes the first increase was the evening dose and next the afternoon one; when attacks occurred on or soon after waking, we advised setting an alarm clock 2 hours before the usual waking time and then taking the medication. Patients were followed-up at weekly intervals until attacks were controlled. They were also reviewed when a cluster period had ended, and advised to continue on the same dose for a further 2 weeks before starting systematic reduction. Chronic cluster patients were reviewed as often as necessary. Results.-Seventy consecutive patients, 52 with episodic CH during cluster periods and 18 with chronic CH, were all treated with verapamil as above. Complete relief from headaches was obtained in 49 (94%) of 52 with episodic, and 10 (55%) of 18 with chronic CH; the majority needed 200 to 480 mg, but 9 in the episodic, and 3 in the chronic group, needed 520 to 960 mg for control. Ten, 2 in the episodic and 8 in the chronic group, with incomplete relief, required additional therapy-lithium, sumatriptan, or sodium valproate. One patient withdrew because verapamil made her too tired, another developed Stevens-Johnson syndrome, and the drug was withdrawn. Conclusions.-Providing the dosage for each individual is adequate, preventing CH with verapamil is highly effective, taken three (occasionally with higher doses, four) times a day. In the majority (94%) with episodic CH steady dose increase under supervision, totally suppressed attacks. However in the chronic variety only 55% were completely relieved, 69% men, but only 20% women. In both groups, for those with partial attack suppression, additional prophylactic drugs or acute treatment was necessary. (Headache 2004;44:1013-1018).

=======================================
SLOW-RELEASE VERAPAMIL

Dr. Sheftell applauded the protocol for verapamil used by Dr. Goadsby and colleagues, which entailed use of short-acting verapamil in increments of 80 mg. “This method was suggested by Lee Kudrow, MD, 20 years ago as an alternative to slow-release verapamil,” Dr. Sheftell noted.

“I would agree with using short-acting verapamil, rather than the sustained-release formulation, in cluster headache,” he said. “I prefer the short-acting formulation with regard to ability to titrate more accurately and safely. My clinical experience anecdotally demonstrates improved responses when patients are switched from sustained-release verapamil to short-acting verapamil.”

Dr. Goadsby agreed that his clinical experience was similar. “There are no well-controlled, placebo-controlled, dose-ranging studies to direct treatment. This is one of those areas where clinicians who treat cluster headache have to combine what modicum of evidence is available with their own clinical experience,” Dr. Sheftell commented.
=====
Still  believe that, given your history, working with a headache specialist is needed.