I've had CH for over 30 years.  At 52, they have started to tail off and I've been lucky enough to go 3 years between cycles the last three times.  This cycle started about 2 weeks ago and is in full bloom.  I have my M tank at home and a bunch of E tanks at the office.  The boss has been briefed.  I have a pile of imitrex from the last time, and an excellent neuro who listens to me and gives me what I need.

I usually only use abortives.  I try to get every one with O2 and use the half imitrex shots to get the ones that break through.  Every once in a great while, I'll have to take the other half of the shot.  I NEVER let these get full blown any more withou aborting them.

I have used prednisone tapers to give myself a break during the cycle and to try to end the cycle toward the end.  If I have to travel, I sometimes go on the prednisone then which gives me a 5 day window when I don't have access to O2.  I hate the way it makes me feel, but it's worth it if it works.

My question is does anyone know the right time to start the prednisone if you're trying to kill the cycle?  I've tried it too early only to have the HAs come back.  My cycles are typically 6-8 weeks, so I'm trying to wait until things get to a steady-state before I start.  But if anyone has any experience with this, I'd love to hear about it.

Thanks

Thanks.

It has ended the cycle for me the last two time.  Although it may have been time for it to end anyway.  I try not to travel during a cycle, but some times there's no choice.  I start the prednisone when I'm about to leave and it usually gives me about 5 days before the HAs start up again.  It beats imitrex jabs every 4 hours which is what happens if I don't have my O2.  Lesser of evils.

I'm like E-Double. There are some people who can break a cycle with steroids, for me they just provide interim relief. So like you, I'll take them if we have a romantic weekend getaway planned and I absolutely don't wanna get hit. Otherwise I just use them at the start while I'm waiting for the lithium to take hold.

Joe

She didn't see the humor.

Yeah....they're funny that way!

Joe

Too many docs are too conservative with the Verap dosing.
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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).

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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.

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and see the PDF file, below

Prednisone, gave me a very nice 4 days this cycle, but the headaches were back before I used up the pills.

Oh way to jump right on my back Jeebs!!

Joe