One benefit: you waited  to "old age" before they made their appearance. <bg>

Two thoughts: 25mg is O.K. but most cluster folks find the injection form faster acting and, probably, more "thorough" in knocking out an attack.

Verap dose is rather low. You may find moving up would keep the shadows away and give longer protection. If you haven't seen it:

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.

You'll hear loads from the O2 crowd! But look at the buttons, left, also.

Results I've seen suggest about 60-70% effective at aborting an attack compared to about 90% for suma. injection.

Print out the PDF file below. Good learning and a handy tool to use as a discussion tool with your doc.

Welcome to the board! The VA will balk at the injections as they are very expensive. It'll take some letter writing by your doc and some pushiness on your part!

the oxygen. I abort in about 6-8 minutes. That's from onset of pain, to complete relief. I'm a 52 year old male, episodic sufferer since the mid 70's. NOTHING has proven as fast and consistently effective at aborting my attacks, with virtually no side effects.

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or

Check out this link for everything you ever wanted to know about 02. Then go to the meds section of the 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 a lot of relief for a lot of people. Cheap, good for you even without CH, worth a shot.

Joe

Again I am new to the forum but by no means new to cluster headaches. The pain they have caused me have damaged my heaert and my eye. I was on verapamil for two years and it seems to calm them a bit my neologist then put me on lithium and clonazapam and topomax and i take imitrex shots as needed more than reccommended dose had to get specail permission from dr, pharmacy and such cause of such high risk of heart attack with every shot but nothing else works and im a two sided cluster headached person so surgury to remove the nerve is not an option sorry for all the mistypes im not a good texter lol