Hi Kevin

Quite a few questions in there.

For the work related ones, there are a few people who worked in that area and your part of the world, so hopefully they should be along soon to answer your work related questions.

Have you been working with a headache specialist? Most doctors, including many neurologists have relatively little to no experience of treating CH, so seeking out someone skilled and experienced in this area is vital to get good treatment.

Some comments from your list of treatments.

• DHE injections - used by some, especially those who also get migraines, but not commonly used
• Imitrex 100 tablets - imitrex is used to abort a CH, however the pill form takes far too long to be absorbed to effectively kill a CH. Most people use the injectable form (as you also do) and some use the nasal spray. Are you using this as a preventive? If so, this is not an effective one with verapamil, lithium and others being significantly better.
• prednisone - a good short term preventive to take whilst a longer term one (like verapamil) builds up. It can cause damage to your body taken long term.
• oxygen 15lpm - oxygen is amazing to kill CHs off quick. Read up the oxygen info on the left for loads of great info. Make sure you're using a non-rebreather mask too. Higher flow rates work even better - for me, 25lpm is twice as quick as 15lpm.

Have you tried energy drinks, like Red Bull, with both caffeine and taurine. They can help reduce the intensity and duration of a CH, just chug it down once a CH starts.

There are people, including myself, taking high doses of vitamin D (Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or ) and getting pretty effective relief.

Keep reading, ask questions and people will try to answer them all.

In case you are not working with a headache specialist:

LOCATING HEADACHE SPECIALIST

1. Search the OUCH site (button on left) for a list of recommended M.D.s.

2. Yellow Pages phone book: look for "Headache Clinics" in the M.D. section and look under "neurologist" where some docs will list speciality areas of practice.

3.  Call your hospital/medical center. They often have an office to assist in finding a physician. You may have to ask for the social worker/patient advocate.

4. Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or On-line screen to find a physician.

5. Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or Look for "Physician Finder" search box. They will send a list of M.D.s for your state.I suggest using this source for several reasons: first, we have read several messages from people who, even seeing neurologists, are unhappy with the quality of care and ATTITUDES they have encountered; second, the clinical director of the Jefferson (Philadelphia) Headache Clinic said, in late 1999, that upwards of 40%+ of U.S. doctors have poor training in treating headache and/or hold attitudes about headache ("hysterical female disorder") which block them from sympathetic and effective work with the patient; third, it's necessary to find a doctor who has experience, skill, and a set of attitudes which give hope of success. This is the best method I know of to find such a physician.

6. Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or NEW certification program for "Headache Medicine" by the United Council for Neurologic Subspecialties, an independent, non-profit, professional medical organization.
        Since this is a new program, the initial listing is limited and so it should be checked each time you have an interest in locating a headache doctor.
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If Imitrex isn't working--and the injection form is the best for Cluster--print out this info and discuss with your doc. Number of us have had excellent results and because it's quite different from Imitrex, it may be worth a try. You will know with 1-3 uses whether it has any potential benefit for you. On a per dose basis, it's much less expensive than Imitrex.
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Headache 2001 Sep;41(8):813-6 

Olanzapine as an Abortive Agent for Cluster Headache.

Rozen TD.

Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. THE INITIAL OLANZAPINE DOSE WAS 5 MG, AND THE DOSE WAS INCREASED TO 10 MG IF THERE WAS NO PAIN RELIEF. THE DOSAGE WAS DECREASED TO 2.5 MG IF THE 5-MG DOSE WAS EFFECTIVE BUT CAUSED ADVERSE EFFECTS. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and TWO PATIENTS BECAME HEADACHE-FREE AFTER TAKING THE DRUG. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. IT ALLEVIATES PAIN QUICKLY AND HAS A CONSISTENT RESPONSE ACROSS MULTIPLE TREATED ATTACKS. IT APPEARS TO WORK IN BOTH EPISODIC AND CHRONIC CLUSTER HEADACHE.

PMID 11576207 PubMed

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Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.
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Since this abstract was first posted Zyprexa has appeared in some lists of recommended meds for CH. [BJ]