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Jennifer, you really need high-flow oxygen (at least 15 lpm, often more) and a high-quality non-rebreather mask. It is very, very often prescribed wrong. If you have CH, a system like this is almost guaranteed to help you. Read more about O2 here: https://clusterbusters.org/oxygen-information/ The mask that makes a big difference is now called the Cluster O2 Kit: http://www.clusterheadaches.com/ccp8/index.php?app=cms&ns=display&ref=splash Hyperbaric oxygen can help abort an attack, but it hasn't shown any effectiveness as a preventive. An optimized "regular" O2 system is what you want. There nothing really "out of the box" about that lidocaine treatment. Lots of people try it. It's called an occipital nerver block, or ONB. I don't think it helps more than 10% of CH patients, from what I've seen. The medical standard for pharmaceutical treatment of CH is verapamil as a preventive, and oxygen and sumatriptan (Imitrex) as abortives. Sumatriptan injections are the most effective form -- it also comes as a nasal spray (often effective) and pills (rarely if ever effective). Taking imitrex pills at night is not going to help much, if at all. Zomig is the nasal spray version of the triptan. Like I said, it's much, much better than the useless pills -- highly effective for many people. Topamax can be effective as a preventive, but as you've seen, the side effects are yucky. I don't know what your verapamil dose was. Many people need a pretty high dose to be effective. There are side effects there also, which need to be monitored. You should start the vitamin D3 regimen right away: https://clusterbusters.org/forums/topic/1308-d3-regimen/ It just might be the most effective preventive there is, not to mention that it generally has no side effects (and is actually good for you, in almost all cases). You mention "steroid shots." Usually steroids (such as prednisone) are given in pill form, as a "taper." They can buy you some pain-free time, but are rarely lastingly effective. How much melatonin are you taking at night? There are people here who go up close to 30mg before it helps them get relief. Have you tried energy shots, such as 5-Hour Energy, at the first sign of an attack? They can abort an attack, or at least significantly reduce the severity of the attack (even in the middle of the night -- they don't keep most people up). Most people who are regulars here use the "busting" method -- taking small amounts of psychedelic substances in a systematic way. Often the amount can be small enough that there are no, or very few, "trip" effects. You can read about that in the numbered files in the ClusterBuster Files section.