Hey Mike,

Sorry you're having a rough time…  but it sure sounds like you're making it harder on yourself by expecting the next medication you take to be a silver bullet that makes the beast go away for ever…  Silver bullets like that flat out do not exist when it comes to cluster headaches…

A week to 10-day prednisone taper should have provided a marked reduction in the frequency and intensity of your attacks.  Many of us found it to be a Godsend as it stopped the attacks for most of the taper and for a very rare few, it stopped their cycle completely… 

Unfortunately for most of us, when the prednisone taper ended, the beast returned…  and too many of us didn't realize we needed that week to 10 days as a transition period to ramp up on a preventative…  What was the prednisone dosage you took?

Oxygen therapy is the closest thing to a silver bullet we have if the flow rate is high enough to support hyperventilation, we start it as soon as we realize an attack is approaching or as fast as possible after an attack starts, and we don't have a comorbid condition that lowers our arterial pH – too much acid.  (Any condition that lowers arterial pH may tend to make the frequency and intensity of cluster headaches higher during the day and more frequent during sleep.)

However, as fantastic and effective as oxygen therapy can be in stopping the pain of a cluster headache very rapidly, it is still only an abortive so will do little to prevent the next attack.

The triptan family of abortives like imitrex (sumatriptan succinate), zomig (zolmitriptan), or maxalt (rizatriptan) tend to work rapidly to abort our attacks when administered by subcutaneous injection, a little slower as a nasal spray, and slower yet in pill form…  As good as they are, they're still abortives.

Even folks who take high enough daily verapamil dosages to cause arrhythmias or slow their hearts…  still have cluster headaches…  so even verapamil isn't a sliver bullet…

In short, there are no silver bullets available today as a prescribed medication… 

That leaves working with your physician to come up with a plan to evaluate different combinations of preventatives and abortives with the goal of coming up with one that provides maximum relief without too many side effects…

In the mean time, taking calcium citrate tablets with vitamin D, magnesium and zinc as well as drinking lemonade may help if your arterial pH is low. 

I use only oxygen therapy and with the exception of an occasional snort of triptan nasal spray during air travel, I take no other abortives or preventatives.  This works for me and I have an excellent quality of life as I spend most of the time in a low cycle of 3 to 4 attacks a week.

I also found that taking four of the mineral supplement tablets each day and drinking one or two glasses of fresh lemonade with lunch and dinner when I go into high cycle of two or more attacks a day/night, tends to push me back into a low cycle.  I also shift my diet away from red meat to fish and chicken.  I up the amount of green veggies too.

Take care,

V/R, Batch