Hello Amanda. I am an episodic sufferer as well and I find Verapamil greatly reduces the severity and frequency of attacks - from 2-3 Kip 9/10 attacks a day to one Kip 5/6 attack every 2 days. It is certainly worth trying as a preventative.

For me, Verapamil is like an on/off switch. Below 480 mg a day, it does nothing for me, but once I get the correct dosage, it works like a charm.

Even with a good preventative, me and most other members here will state that you'll need a good abortive to back it up. As such, Oxygen is strongly, strongly recommended.

Sumatriptan can be very effective (injectable #1, nasal spray distant 2nd, tablet distant distant 3rd) but it is a rather powerful drug. Like any drug, long term use can do damage to your system. Used correctly, Oxygen is fast and effective at aborting an attack and since it isn't a drug, it's almost 100% safe. (I say almost 100% as pretty much anything can be misused in an unsafe way.)

You come here having seen a doc who appears to know what he's doing. You don't know about the meds he is suggesting. Then you tell us you won't use them even before you get any of the information you asked for.

Can you see any contradiction here?

Well, verapamil caused my legs/feet to swell so badly that I couldn't get my shoes on. Also, I experienced heart palpitations. That being said, it has been the most effective treatment for me so far (except for Topamax, which I could not tolerate at all.)

I hope I didn't scare you with the harmful side effects bit. Don't be afraid to take the medications at the doctor's recommended dosage. The biggest danger is probably from taking far more sumatriptan in one day than recommended - when Kip 10's strike, all reason goes out the window. But if it's only used as a backup to Oxygen, an overdose unlikely to happen.

And yes, you can't really go wrong with oxygen.

The standard treatment for Cluster involves 3 different meds used at different stages:
1. Prednisone is used as a first med to rapidly stop attacks. Taken for about 14-days and it usually stops attacks within a day, then tapered off to zero.
2. While starting it, you also start a med which works to reduce the frequency/severity of attacks. Verapamil is the most widely used and safe of several preventives but it takes a couple of weeks to become fully effect, hence the Prednisone for the short period.
3. An abortive used for breakthru attacks. They are rapid acting but with short useful life.

There are a variety of meds in each of these three groups which may be used, but all serve the same basic functions.

Print out the PDF file, below, both for your education and to use as tool to discussion treatment options with the doc.
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For your overall education re. Cluster:


Cluster headache.
From: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or (Orphanet Journal of Rare Diseases)
[Easy to read; one of the better overview articles I've seen. Suggest printing the full length article--link, line above--if you are serious about keeping a good medical library on the subject.]

Leroux E, Ducros A.

ABSTRACT: Cluster headache (CH) is a primary headache disease characterized by recurrent short-lasting attacks (15 to 180 minutes) of excruciating unilateral periorbital pain accompanied by ipsilateral autonomic signs (lacrimation, nasal congestion, ptosis, miosis, lid edema, redness of the eye). It affects young adults, predominantly males. Prevalence is estimated at 0.5-1.0/1,000. CH has a circannual and circadian periodicity, attacks being clustered (hence the name) in bouts that can occur during specific months of the year. ALCOHOL IS THE ONLY DIETARY TRIGGER OF CH, STRONG ODORS (MAINLY SOLVENTS AND CIGARETTE SMOKE) AND NAPPING MAY ALSO TRIGGER CH ATTACKS. During bouts, attacks may happen at precise hours, especially during the night. During the attacks, patients tend to be restless. CH may be episodic or chronic, depending on the presence of remission periods. CH IS ASSOCIATED WITH TRIGEMINOVASCULAR ACTIVATION AND NEUROENDOCRINE AND VEGETATIVE DISTURBANCES, HOWEVER, THE PRECISE CAUSATIVE MECHANISMS REMAIN UNKNOWN. Involvement of the hypothalamus (a structure regulating endocrine function and sleep-wake rhythms) has been confirmed, explaining, at least in part, the cyclic aspects of CH. The disease is familial in about 10% of cases. Genetic factors play a role in CH susceptibility, and a causative role has been suggested for the hypocretin receptor gene. Diagnosis is clinical. Differential diagnoses include other primary headache diseases such as migraine, paroxysmal hemicrania and SUNCT syndrome. At present, there is no curative treatment. There are efficient treatments to shorten the painful attacks (acute treatments) and to reduce the number of daily attacks (prophylactic treatments). Acute treatment is based on subcutaneous administration of sumatriptan and high-flow oxygen. Verapamil, lithium, methysergide, prednisone, greater occipital nerve blocks and topiramate may be used for prophylaxis. In refractory cases, deep-brain stimulation of the hypothalamus and greater occipital nerve stimulators have been tried in experimental settings.THE DISEASE COURSE OVER A LIFETIME IS UNPREDICTABLE. Some patients have only one period of attacks, while in others the disease evolves from episodic to chronic form.

PMID: 18651939 [PubMed]
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Also explore:


Three sites which are worth your attention: medical literature, films, plus the expected information
about CH.

Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or
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Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or Search under "cluster headache"
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Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to or
  Full of articles, blogs, book: written by one of the best headache docs in the Chicago area.
  Worth exploring. The latest book is in e-book edition, $10; comprehensive and worth buying for
  a careful read.
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As you begin to use any combination of meds you will have to adjust dosing to find what works for you and/or change to a different med, for not all work with equal effectiveness with all of us. I.E., patience is a survival skill when dealing with Cluster, second in value only to knowing as much or more than your doc. Both formal studies and our collective experience show how limited is the knowledge/skill of many docs around Cluster. Means we need to have some good, informed judgment about whether our treatment is usefu or whether it's time to find another doc.

My point being: patience plus self-confidence that you have done your homework in learning how to care for yourself.

Read, read here; learn (with some reasoned skepticism <bg>!)