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Salt', you really should be considering the Vitamin D3 regimen for prevention. Just as effective as verapamil (probably consideably better, actually) , and a whole lot better for you! I think this is an up-to-date reference -- https://vitamindwiki.com/Cluster+headaches+substantially+reduced+by+10%2C000+IU+of+Vitamin+D+and+cofactors+in+80+percent+of+people -- but I'm never really sure.

I am using this to stay connected with the folks that just finished the Zoom support meeting, Faith, Eric. Charles and Jorge. Than you all so much - it was great for me and we will do it again. Respond to this thread so I know we have connected. TomSwift

This is the management suggestion from UP To Date, a widely used physician reference: Verapamil is the agent of choice for the initial preventive therapy of cluster headache. Glucocorticoids may be used adjunctively to help suppress attacks during the initial titration of verapamil or alone when cluster attacks are infrequent and short. (See 'Verapamil' below and 'Glucocorticoids' below.) Other agents that may be effective include galcanezumab, lithium, and topiramate. Verapamil — Verapamil is the drug of choice for prophylaxis of episodic and chronic cluster headache [3,43]. Verapamil is usually started at a total daily dose of 240 mg. Both the regular- and sustained-release formulations are useful, but no direct comparative studies are available. Patients treated with regular-release verapamil should receive the total dose in three divided doses a day, while those treated with the sustained-release formulation should receive two divided doses a day. There are multiple titration methods when treating cluster headache with verapamil: ●We suggest starting at 80 mg three times daily and increasing the total daily dose by 80 mg every 10 to 14 days as tolerated. ●As an alternate titration regimen, verapamil may be initiated with a short course of prednisone. In a short-term treatment trial [44], patients started verapamil at 40 mg three times daily and increased every three days up to a total daily dose of 360 mg. Those additionally assigned to daily prednisone 100 mg for five days and tapering by 20 mg every three days had fewer cluster attacks in the first week than those assigned to placebo (difference -2.4 attacks; 95% CI -4.8 to -0.03). Most patients respond to a total daily dose of 240 to 480 mg. However, clinical experience suggests that some patients require a total daily dose of up to 960 mg to obtain full prophylactic benefit [1,45]. In an early open label trial, titration up to a total daily verapamil dose of 1200 mg was employed [46]. Thus, an adequate verapamil trial for most patients entails use of a total daily dose of 480 mg to 960 mg before the medication is regarded as a failure. The benefit of verapamil is usually seen within two to three weeks. When the bout is ended, verapamil must not be ended abruptly but should be gradually reduced over two to four weeks depending on the dose and finally stopped. The use of high-dose verapamil is associated with an increased incidence of electrocardiographic (ECG) abnormalities, including heart block and bradycardia [47,48]. Therefore, an ECG should be obtained after each dose increment above a total daily dose of 480 mg. Some experts recommend getting a pretreatment ECG to screen for baseline cardiac arrhythmia [49]. Other side effects of verapamil include edema, gastrointestinal discomfort, constipation, dull headache, and gingival hyperplasia. However, verapamil is usually well tolerated and can be used safely in conjunction with sumatriptan, ergotamine, glucocorticoids, and other preventive agents. The efficacy of verapamil for prevention in cluster headache comes from observational experience and some trial data [3,46,50,51]. In one trial of 30 patients, daily verapamil at 360 mg in three divided doses reduced cluster headache attack frequency and analgesic consumption [43]. During the first week of treatment, the median number of daily attacks, the primary outcome measure, was similar for patients treated with verapamil and placebo (1.1 versus 1.7). However, in the second week, the median number of daily attacks was significantly lower for patients treated with verapamil (0.6 versus 1.7). Additionally, only those assigned to verapamil reported a reduction in headache frequency of >50 percent at two weeks (12 of 15 [80 percent] versus 0 of 15)

Hey SaltLife, My daily dose is 720 divided over three intakes of 240 in the morning, before lunch and after dinner. I have been increasing my dosage since my first diagnosis (was 240mg) as many will tell that one needs increasingly more to prevent the beast coming out. I've been up to 940mg at times, and some have had 1100mg a day, but this can not be done without consulting a cardiologist, in fact with every increase it is good to have your heart checked first (ECG) to see if it technically capable to deal with an increase. Besides this i am in the 'chronic camp' and have more meds as preventive (triptans).

I just wish we knew more abt ivermectin. Hang around other dog n horse people and they can really have insights into different medicines and different applications. I've heard it bandied about for well over 20 years that ivermectin stimmed the immune system. But its barely been looked at seriously. So consequences? You just don't always know... that's all. I try not to get too eager? Because i can go down that path easily. No medicine is always okay, all meds have good and bad and consequences. I think our exposure to herbals has tinted our perspectives so we think our little world can't be rocked with negatives. One just need remember any medicine can have its drawbacks. Ounce prevention worth pound of cure, & alll that~~☆~~ thats sonething people with chas understand, usually. It was and is, i believe, your choice.

Yeah, I’m episodic and mine always start off sort of low key. They usually ramp up in frequency and amplitude until I’m going full tilt, 4-6 hits a night at peak. Although I’m not as clockwork regular as some. I’ve even had a few low level hits and then not gone into cycle. Like a miss or something. But usually when I start feeling pain on my right side, I get my stuff ready to rock. Better safe than sorry. I got caught out of oxygen once when a cycle started going, thinking maybe I’d miss, and I paid the Piper. One time of that was enough, I’m not doing a repeat of that debacle. So I concur with the seasoned veterans above. Time to get your stuff sorted. Better safe than sorry, and all that.

CH warning shot.....

Hi Mr. Jaques, A lot of people with CH get what is referred to on here as shadows (mild but bothersome pain/headache) prior to an onset and some like myself shadow on a daily basis. Also is the headache on the same side that you had your last CH? It's hard to say if your remission is ending or if you just have some odd headache. Just incase you are going back in you might want to consider loading up on the D3 and co-factors if you do not take them on a normal basis you can find the loading instructions and list of supplements by poking around this forum. When you were diagnosed, did your PCP put you on any preventative meds or have you just been lucky and had the CH take a hike for four years? I hope you just have a strange headache!