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Hiya Amy, 1. I live in Canada and my pharmacist says the Imitrex injectable vials are "discontinued." I have only ever used Imitrex nasal spray but they leave me feeling dizzy and eventually stop working early in my cycle. I would like to use the injectable form next cycle- any suggestions for me to find this on my own? Not sure why we keep hearing this…I don’t think it’s correct…check out these threads.. https://clusterbusters.org/forums/topic/5614-imitrex-injections-discontinued-in-canada/?tab=comments#comment-56604 https://clusterbusters.org/forums/topic/5745-my-experience-with-ch/?tab=comments#comment-57517 Suspect that in this world of statdoses and convenience there is a low demand so a low supply for a product requiring syringes, vials and draw ups. I never thot a big deal….but ??? Injectable should be quicker. Many folks find that the statdoses are too big a hammer (4-6 mg) and get by with 2-3 mg after dose pen tear down or the aforementioned vials….and therefore fewer side effects and possibly lesser chance of rebounds or negative cycle effects… (edit...sorry...didn't see CHf reply) 2. I read that Zomig may be more effective - is this in a nasal spray or injectable as well? Should I try that next cycle if I can't get the injectable Imitrex? It's nasal spray, I use the 5 mg version as my abort of last resort when oxygen, energy drinks and (formerly) verapamil insufficient. For me is superior to imitrex: 99+% effective within 10 mins, 18 hr ‘free” time, minimal side effects, no rebounds, no negative cycle effects, easily carried, unobtrusive usage. Similar (HIGH) price to other triptans…comes in boxes of 6. It would be really neat if you could get a sample from your doc to try…as my experience may be unusual… 3. Verapamil - first time I was prescribed it as a preventative I began taking it in July (2013- expected cycle) and had shadows. Verapamil worked to prevent the cycle and I stayed on it for 6 months to xmas. I weaned off Verapamil a few days before xmas and 2 days later the beast hit. The verapamil only delayed the cycle but it often feels like it won't let me get away with anything without taking me down first!!!! Whether to stay on or change dosage or form is a question only you and your doc can answer. I stayed on IR year-round because of rapid on/off CH cycling. Many (not ALL) find immediate release (IR) superior to extended release (ER). Sweet spot reported to be 480 mg/dy in divided doses….I would go over 1000 mg in high cycle….timed to expected hit times being somewhat more effective…. 4. I am into week 4 of my current cycle. The Vit D protocol and Verapamil together bring down the intensity and frequency of the hits. I have had a few PF nights. However, this morning I woke up from a dream ( as usual - most of my attacks come right out of REM sleep) at 5am to an intense HA that I first tried to hit with oxygen, then Immitrex....then gave up wimpering in the shower and sobbing myself to sleep. The lastest addition to my clusters is the Panic Attack which has me vomiting along with the beast. The lorazapem helps to relax me so I can focus on just breathing through the beast. Four hours later, I woke up feeling dizzy, weak, exhausted with no head ache. This usually signals the end of my cycle. So why when I see the effects of the verapamil and Vit D for a week or more do I still get whacked at least one good time before the beast quits? It's like he has to win every god damn time!!!!! When episodic (years) I knew that the cycle was over when I got BLASTED by the worst hit of the cycle (which is saying a LOT). Used to crave-yearn-pray for that hit…weird yes, but I KNEW what it meant. The “beast” as an entity vs a medical condition would be affirmed by many a clusterhead…it seems to be “alive”, with a will, a vindictiveness, and an evil intent that is spooky……….. Many find energy drinks…drank COLD and FAST at first sign of a hit…then hit the O2… to be quite effective. Minimum 100 mg caffeine and 1000 mg taurine (caffeine booster)…bought by price not brand as they mostly taste AWFUL....which at the time I don't care. The 2 oz 5-hr energy drinks have the advantage of portability and quick use. Lotsa sugar in most….look for sugar free WITHOUT aspartame (a trigger). I purchased at discount grocery stores for less than a buck per... Sorry for the rant. As you all will agree, no one really understands what I am going unless you have been there with me Aint no rants in clusterville…we share…yours nicely written! Best Jon

We have heard the rumor before about injectable Imitrex not being available in Canada. From all reports, it isn't true. There was some kind of a shortage a while back. I'm a little confused by what you have written because vials are not the same thing as the autoinjector. With vials, you get the Imitrex and you use a syringe to draw the amount you want out of the vial; autoinjectors come filled with sumatriptan and a syringe needle, you push a button to inject it. I don't know of the status of vials in Canada. They are definitely a better way to go because you can use only what you need, which for most people is about 2 or 3mg, whereas the standard autoinjector has much more than you need, 6 mg. Many people take apart the autoinjector so they can give themselves injections of smaller amounts, but that's not simple to do for everyone. There is also a 4 mg autoinjector of sumatriptan. I don't remember the brand name. This is kind of a compromise -- it's still more sumatriptan than you need, but at least it's not 6 mg. I'm pretty sure that Zomig is just a nasal spray. It's a different triptan (zolmitriptan). Don't know if it would affect you differently.

Busting is a topic I don't know enough about, as I am trying to learn that myself. However, I have a few tricks I have learned: OXYGEN is your best friend. There is no actual difference between welding oxygen and medical oxygen (only the cleanliness of the tank). Oxygen is your first and best line of defense. I have found that oxygen will abort an attack almost as fast as an imitrex injection without any of the side effects. You need, at a minimum, a flow rate of15LPM through a non-rebreather mask for 15min. When you go to your doctor, make sure s/he specifies the flow rate and non-rebreather mask (the one with the bag on it). Much more about oxygen can be found here: https://ashleyhattle.com/how-to-get-and-use-oxygen-for-clusterheadaches/ (This is a link to the website of a Clusterbusters board member who literally wrote the book on Cluster headaches) It wouldn't hurt to get the book either, I found it informative and encouraging. Also, there is a lot of information on this board about oxygen. Everyone does it a little differently, but most people have great success with it. A key point is that if it does not work for you at 15 LPM, increase the flow rate and try again. For me, 15LPM will work, but I do better with 25LPM. ENERGY DRINKS are helpful at holding off an attack and are also used in conjunction with oxygen to abort attacks. The combination of taurine and caffeine is apparently what does the trick. I used to slug a cup of coffee to hold off an attack, but the caffeine/taurine combo works better. Look into the D3 Regimen. A cluster headache sufferer put this anti-inflammatory regimen together and cured his headaches. Essentially, it is a bunch of vitamins in conjunction with large doses of vitamin D3. This forum has a lot of information about the D3 regimen, and Batch (the creator of the regimen) is a very regular contributor to this board and is always willing to personally help. Many people have a reduction in frequency and severity of their CH using the D3 regimen. I have those morning hits sometimes too. It sucks to wake up, go through hell, pop an injection, and then have to go about your day. Oxygen has made that bearable. Trex messes with me, makes me drowsy and worthless. Oxygen does none of this. I have also been able to drastically cut back the shadows with oxygen as well. I have recently stopped taking imitrex, and rely solely on O2 and Energy Drinks for aborts. (I still stockpile the injections for a rainy day, however). Also, there is some evidence that imitrex can make your cycles longer. When things were really bad I would take imitrex tablets as a preventative (I could prevent an attack for 12 hours with this method). It sounds like you may be experiencing something similar. Most importantly though, we have all been there. You don't have to put how you feel into words. Those feelings of despair are (in a way) a symptom of this condition. You are also suffering from PTSD (we all are). That helpless feeling you get when you got yet another attack is part of it and there are a lot of people on this board who know exactly what you are going through, and are willing to help. This simple fact did not keep a cycle at bay, or help abort any attack. But it gave me some hope that things would get better in the future. Congratulations on the baby, you have a whole new world to look forward to.