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Richard C


Diagnosis: Chronic cluster
Clusters started: 2005

Retired Navy officer

Following is the current cluster; began in March of 2012:

Headache Log March, 2012:

March 6 began a series of daily pain level 2-3 headaches. Treated them with Imitrex inhalers and Oxygen. Sumatriptan 50 seems to be ineffective at this point. Usually get one, sometimes two, episodes per day, lasting up to 10 minutes. Have elected to not start Prednisone due to low intensity and short duration.
March 17 (approx) Frequency increased to about three per day. Using three Imitrex inhalers and one or two Sumatriptan 50 tablets; seem to now have some proactive effect. Pain level is usually 2 or 3 – but occasionally 4 or 5.
April 10 (approx) Pain level for some events increased to level 8. Duration of episodes has increased – in some cases, taking an Imitrix inhaler at the onset only diminishes the pain to level 3 or 4; about every 2 or 3 days, I have had to take a second inhaler at about the 25-30 minute mark for complete pain relief about 10 minutes later. After these events, I feel near-total exhaustion after the pain is gone. For “minor” events, treatment with oxygen at high flow (10 L/min) and a cool, wet compress works within 10 minutes alone.
May 3 and 5 Visited an acupuncturist. Not ready yet to be a “believer,” but while headaches continue at two or three a day, they are only pain level 3 or 4 (of 10) – none in the level 7 or 8 experienced immediately before treatments.
Continuing, no respite… Headaches have continued on a near-daily basis, but at a lower intensity – level 2-4/10. Treatable with oxygen and a dark, quiet environment. Usually last only 5 – 15 minutes.
December 29 Significant event: 3:00 (P.M.) pressure; 3:30 level 3 – 4 (of 10) pain, used oxygen and Naratriptin tablet; 4:00 level 7 – 8 pain, no tearing or sweating; 5:00 took Imitrix spray. Pain abated to level 3 after 20 minutes. Used intermittent Oxygen until 6:00.

January 2, 2013 Minor event 4:00 – 8:00. Pain intermittent to level 2 (of 10). Used mostly oxygen – useful, for about 20 minutes after 5-minute application. Took Naratriptan tablet about 6:45 – limited effect. Also took Excedrin “Migraine” tablets (2) about 7:30; some limited effect.

Series: Feb 22-23. 3 or 4 low-level headaches (pain level 3 of 10) per day, usually in the afternoon/evening. Controlled with Imitrix spray and oxygen.

Night of February 23/24 - awakened by level 3-4 (of 10) pain at 2200, 0200, and 0400. Treated with Oxygen each case, except supplemented 0400 with Imitrix spray. Took Sumatriptan 100 about 0700 abortively, due to residual pressure. About 1000, February 24, had a level 3-4 breakthrough event; treated it with Imitrix and Oxygen, which was effective in 5 minutes. Took Amerge about 1130.

Significant event: 1730, February 24, began level 8-9 pain headache, lasting 2 hours (worst headache since cluster began a year ago), followed by level 2-3 pain for two hours. Used one more Imitrix spray (ineffective) and Oxygen (had to ration, because supply was running low.) Very sensitive to light & sound. Tearing both eyes. Probably overdosed on Sumatriptan…

Have been taking Verapamil as prescribed (80 breakfast, 160 lunch, 80 supper) and Topirimate 50 (breakfast and 1500), plus Naratriptan 2.5 at lunch.

(Headaches continue at the rate of about two/day, pain level 3 or 4 on pain scale 10)

Starting Saturday, March 2, about 1000, headaches of pain level 3 (of 10) began every 3-4 hours, day and night. Usually treated effectively only with oxygen. In an effort to get some relief from the cycle, I used a Sumatriptan Inhaler at 0630, Monday, March 4; this was effective until 1230, when I began an attack of level 8; at 1250, I used the second inhaler of the day – effective in 10 minutes. Used oxygen throughout. Tearing right side. This headache followed the taking of one Amerge 1.5 hours prior to the onset.

March 5 Minor (pain level 2 of 10) events at 0430 and 0630, treated with oxygen only for 5 minutes. Level 5 at 0730 for 20 minutes; took a Sumatriptan 100 tablet at 0750 to (successfully) break the mini-cycle.

March 7 Minor event 1030 (10 minutes, level 3 of 10). Major event at 1830 level 9 pain for 20 minutes. Used one Sumatriptan spray at 1850. Pain eased to level 5 at 1915, then to level 2-3 for 30 minutes. Used oxygen throughout. Took Amerge about 1100.

March 8 1100 (Had just taken Amerge) Began level 6 headache. Took Sumatriptan spray at 40 minutes, which was marginally effective. 30 more minutes at level 5-6. Is Amerge doing its job?

Headaches continue at the rate of 2 or 3 a day, usually pain level 3, lasting 10-15 minutes, treated with oxygen only. Have converted to Lyrica, Migranal and Dihydroergotamine Mesylate

March 18 1745 level 7-9 pain; 1810 used Migranal spray; 1825 gave self injection of Dihydroergotamine Mesylate; 1840 pain level 2-3 for next 20 minutes, then no pain.

Not sure Lyrica or Migranal works for me.

March 26 1715 level 8-9 pain for 90 minutes; 1810 gave self injection of Dihydroergotamine Mesylate; some relief after 20 minutes; continued level 2 pain until about 2000.

Headaches continue at 2 or 3 a day, pain level 3 or 4. Using 1 or 2 E-tanks of oxygen a day.

April 9 several level 3 or 4 headaches from 1530 to 1800, each lasting about 20 minutes and responding well to oxygen. 1915 level 7-8 began; 1850; 1850 gave self injection of Dihydroergotamine Mesylate; 1945 pain free … took 30-40 minutes for the injection to be effective. Used oxygen throughout.

April 15/16 series of headaches, about one per hour, starting about 1400, pain level 3 or 4, treated with oxygen. Some success with continuous oxygen at flow rate 4 or 6. Pain level 6 to 8 series of three headaches between 2100 and 0030; gave self injection of Dihydroergotamine Mesylate at 0030. No further problem, except for lethargy the next day.

April 19 Starting at 1300, had a series of headaches – about one per hour – each lasting 20-30 minutes, pain level 3-6. At 2120, decided that if I were to get any sleep, I needed to give myself an injection. Earlier headaches were treated with oxygen, Migranal, and cool compresses only.


Date Event
Jan 2003 sample event
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