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The frustrating thing, at least for me reading this, is that somehow CH is not enough of a doggone disability. You should get a friggin medal and a lifetime pension from your organization for what you've accomplished while dealing with chronic CH. This study looked into cognitive impairment in people with CH, but didn't find anything significant. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4354253/ Maybe there are other studies showing different things. An interesting sentence from it: "When patients were asked to rate the severity of their own cognitive failures, patients with CCH reported higher cognitive failures than the ECH patients, and statistically significantly higher failures than HCs." ("HCs" being healthy controls.) But it didn't show up on the tests. You have done your homework, so I'm just gonna say a bunch of stuff that I feel pretty sure you already know. The one you don't know yet is the D3, which could be a game changer. Busting has been the salvation of many folks with chronic and episodic CH. A "last resort" that many wish they had turned to first. Do you know to try an energy shot (5-Hour Energy, for example) at the first sign of an attack? It can stop them, or reduce their severity. Batch says drinking icy cold water from a straw, aiming to create a kind of brain freeze, will help as much as the energy shot. Increasingly, it is being noticed that pollen worsens CH for most people. Many get some or a lot of relief from just taking Benadryl -- some every day, but more during high pollen seasons. If your business on the road is by car, can't you bring a small O2 tank with you? If it involves flying, you can usually arrange to get O2 at a destination, through your O2 supplier. (Again -- apologizing since you almost certainly already know all this. No need for you to reply.) Many people get quicker aborts with higher flow rates (buying the higher-flow regulator) and from the mask made for CH: http://www.clusterheadaches.com/ccp8/ Is verapamil ruled out because of your heart issues? The required daily dose can go as high as 960mg, which is much higher than most people are typically prescribed. The zonisamide if of course another anti-seizure drug. We've had some people here from whom other anti-seizure meds, such as gabapentin, have worked well . . . but for most the side effects are rough ("problems with thinking or speech; trouble concentrating" are among them). Elavil/amitryptiline has been very positively reviewed by some folks here, at least in the short run (we don't generally hear back from folks who find something that works). As usual with CH treatments, mileage varies all over the place.

Lloyd, I suppose the fact that I don't know what VML is suggests that I'm not going to have a good answer for you. This study was posted some years back, and it mentions demyelination. https://thejournalofheadacheandpain.springeropen.com/track/pdf/10.1186/1129-2377-14-64?site=thejournalofheadacheandpain.springeropen.com It's my could-be-wrong belief that there are some occasions in which CH has been shown to be caused by lesions, but most often it's the other way around, that CH (and migraines, which you mention) cause lesions. A lot of folks notice memory issues. There's a thread about it here -- https://clusterbusters.org/forums/topic/4279-short-term-memory/ -- and probably others. A few posts down in that thread, Bejeeber mentions something he takes to help with memory issues. Are you asking because you are thinking of applying for SSDI disability? Meanwhile, let's talk about what you're doing for your CH (if you want to). I'd bet that as a chronic you have tried lots and lots of things, but one thing we keep finding is that even with the medical/pharmaceutical things that have been tried, there has been some shortcoming in the prescription or the method of use that has kept it from being fully effective. What's helping you now? Oxygen? Verapamil? Imitrex?? Since you're just getting started here, let me strongly recommend that you read through the files in the ClusterBuster Files section, paying particular attention to the file about the "D3 regimen" (which you should almost certainly start right away) and the numbered files, which are about "busting."

Well I didn't have any shadows yesterday at all so i was hopeful went I went to bed last night. I was actually looking forward to going to sleep instead of being terrified of it. Went to bed at 2am (I'm a late nighter) and wouldn't you know it at 5am I had to jump out of bed. The difference was this time it was because of my 61 year old bladder. Did my business and back to sleep. Woke back up at 10am this morning after another restful night other than the bladder call. I gotta tell you I am almost in tears right now. After 15 years of fighting the beast I've never had a break like this during a cycle. Hoping it continues. I did download the new D3 info and will look through it today. I also want to state for anyone reading this that I have been on this site for quite some time but never really post. However if it wasn't for this site and the information I've gained from it I may well be another reason they call CH suicide headaches. I've had cycles so bad that I've literally banged my head against the door jam to the point of bleeding just to try and focus the pain elsewhere. I thank God for this site and the people who work so hard for all of us who battle this beast and I thank God for the woman who has stood by me through all of the terrifying nights we've been through. So thank you to all of you from the bottom of my heart.