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kat', I suppose you have checked this out thoroughly, but from looking on google, it seems like there are lots of welding O2 rental places in Puerto Rico, and also maybe a place where you could rent a concentrator, which might be better than nothing (https://www.rentittoday.com/medical-equipment-rentals/san-juan-puerto-rico-portable-oxygen-concentrator-rental-for-cruise-ship-22966). Maybe it's more of a hassle than you want to go through on vacation, or even too much of an expense. But maybe worth bringing your mask and regulator just in case. Another thought is that you might try some of the FaceBook CH groups and just put out a request for whether there's anyone who lives in PR who might be willing to loan/rent you a tank, or can recommend a place to get one. (I don't expect much to come from this, but I sent a message to the Puerto Rico Tourism Company, asking about getting O2. Many years ago, I actually worked for them, doing training at resort hotels on the island.) Story about a PR neurologist: https://www.latinoleadersmagazine.com/marchapril2022/2022/5/11/i-can-feel-your-pain-dr-franchesca-fiorito-headache-center-in-puerto-rico

I've not been in cycle for a few years now and O2 is my primary abortive when I am. I have not used a triptan in very, very long time, but I still carry one in my pocket everywhere. I will not be caught out and get slapped around again. They have a place in our treatment plan but IMHO they should not be a primary abortive. The more you use them, the more you need to use them. People may deny that, but they are only fooling themselves.

Great plan, hope you have an awesome vacation!

Well said. I could not agree more.

@spiny yep I already got all my meds filled here! I’m not gonna fight with the insurance on the zomig nasal spray there is no point. I’m gonna ask my neuro if he has any samples. I’ll definitely bring some extra sputs. Not sure where to put them though.

Interesting Miilos. Of course many of us use coffee or an Energy Drink for a Cluster, so I do get the point that sometimes too much coffee is required. It just leaves one feeling jittery and 'not right'. How many times a day are you needing caffeine? Can you tell us where you are located? Are you getting the pain only on one side or are you getting both? Did the tests include a MRI? How did your doctor come to the diagnosis of Vasodilation Headache? I normally see that with reference to a particular medication, not a stand alone disease. Not that it isn't there! It very well could be and I just have not heard of it. Here are some medications associated with Vascular Dilation Headaches: Many drugs can cause vascular headaches by inducing vasodilation. These include antihistamines, sympathomimetic agents, amyl nitrate, nitroglycerin, nicotinic acid, hydralazine, prazosin, pentoxifylline, cyclandelate, nifedipine, perhexiline, theophylline, aminophylline, terbutaline, and dipyridamole. This is the D3 Regimen. The original and it contains fewer vitamins to take, as it is not so focused on anti-inflammatory and histamine. https://vitamindwiki.com/tiki-download_wiki_attachment.php?attId=7708 It has helped many a cluster-head get out of pain and stay there for extended times. There is a more extensive one as well if this does not work. Are you taking any other medication that would affect your head? Like for heart issues or similar?? Next question: If you are only getting them a 'few times' a month, then why the concern over the caffeine? Does each headache require several cups of coffee to keep it at bay?

With your plans as stated Kat, I don't see you needing the O2. If you do, head to the fire station perhaps? They are often more helpful than the ER. Considering where you are going, it may just be hard to put your hands on period! With that being said, your plan sounds solid. Perhaps pack some extra SPUT's just in case? I would get that Pred script filled here of course and keep it on hand. But I am prone to doing that just on general principles for emergencies. It pays to already have it before you need it! In the last 20 years, I have kept a taper pack on hand at all times for emergencies. It has saved my bacon more than once too. So, if there is a refill on that script, get it while it is still in date. Your doctor is pretty smart to give you the Valium. I am surprised that he gave you Xanax too, but hey, stash away what you don't use of either in a sealed bag and keep it for another time. Valium has a longer half-life, so it is better in that it lasts longer. Fill your scripts, do your busts, and have a ball!!! Fingers crossed that you come away from this trip with a huge smile and a newly found freedom.

I so appreciate being able to come on here and talk through any concerns I’m having with my CH. it’s much easier than talking to family. My trip to Puerto Rico is 5 weeks away, and I wanted to go over my plan with you all to see if there is anything I should add, avoid, or improve. 2 weeks before my trip I plan on busting with MM at least twice. I also talked to my doctor about increasing my verapamil slightly. He told me it would be fine for the trip, since my blood pressure is good. He thinks I’m on too low of a dose anyway. I am on 80mg 3x per day currently. I do not have a way to get oxygen on the plane or at my destination; so I will have to do without. I am planning on loading on D3 and the cofactors a week before the trip. As for MM, a SPUT will be taken on the runway as well. I will be plenty hydrated and I’ll buy some Red Bulls before hand. I expressed to my doctor that my concern wasn’t so much getting hit on the plane (although that would SUCK), but mostly having multiple hits while on my vacation. He gave me a steroid taper he said I should take if I start to experience hits while over there. He also told me that could help with the flight back as well to avoid a hit. He also prescribed Xanax and Valium for the flight because he said any high stress leading to the morning of the flight would likely trigger an attack. Any thoughts here? The only nasal spray I have is the ergotamine. Much love to you all. My hope is I am pain free and I can start traveling and enjoying life again.

I bet that you figure that out!

Hi Chloe, I am thankful you read my post. I hope this may be an answer for you as I too have had my life nearly destroyed by CH. please understand that Ketamine does not need to be a last resort medication as there are clinics here that are starting to use it for CH and many other difficult to treat disorders. I wonder if there are any clinics where you are located. Most of these clinics are treating Severe Depression, Anxiety and Migraines that have not responded to other treatments and they are getting amazing results. The Clinic name: Reichbach Center https://www.findpainrelief.com/ 941-213-4444 Please call and talk to Dr Reichbach, he would gladly speak with you. He is not like so many other doctors I have dealt with, he genuinely cares and understands what we are going through. Knowing now what I know, I will say this, I believe this will help you. I do not believe I am unique because Dr. Reichbach has seen many CH patients have the amazing results that I have had. You are in my prayers. Sincerely, Laurie S.

....yup, same for me over the years about half the time because some insurance providers covered and some didn't. some O2 shops are stubborn about this and you may need to shop around....go talk to them in person so you are a face and not a phone call. funny (not ha ha) turned out that self pay or ins copay was exact same $ out of pocket. still, there are advantages to being covered, as it means your diagnosis is more recognized in the system (insurance and O2 shops) and that could be important down the line. i'd start out self pay then work toward coverage. an advocate doc (find a headache specialist if at all possible) in the process can be critical, as a "letter of medical necessity" can (and did for me) change denials. and always, ALWAYS, ALWAYS APPEAL any denial from an insurance company...always seemed to me that the first denial was automatic and they were hoping you would just go away... DON'T. and besides the doctors note, provide any documentation of medical lit/research supporting your claim (e.g. oxygen along with triptans is medically recognized as THE primary abortives(s) for CH).... and besides, O2 is WAY cheaper than triptans, w/o the rebounds and nasty side effects......

if you can get the prescription you can call all the oxygen supply houses in your area and tell them you have no insurance and will self pay. It turned out to cost me less money doing it this way. you do not need anything other that the full tanks from them as you will want to buy your own high flow regulators online and a cluster mask that allows more 02 intake and no outside air.

As someone who somehow hasn't had any bad experiences with countless injected doses of imitrex, I still agree with Jon'n Bosco, whom I may now refer to collectively as JoBo. Same regarding this: I do thank my lucky stars I was able to find my way to this community/forum and embed here before FB groups were a thing.

... this made me smile cuz i been there... once was lead on a critical sales presentation to some very important clients.... was seated between company President and VP having to prove myself to them too. a hit started right when i did, and quickly got to an 8...there was NO out, i just had to keep going for 45 mins. when the tears started leaking hit side i turned my head so they wouldn't see. might have been the bravest thing i ever did in my life..... and i have no recall of anything i said.... but i made the damn sale! they might have wondered why after the handshakes i ran out of the room tho...... .. thanks for sharing... triptans have their place... i never go anywhere w/o a Zomig ns..... but only as a last resort abort for years now. too many of us know exactly what you experienced.....

Got to love a straight shooter I completely agree with @jon019 on this one. This bit just makes me wonder about the influence being interjected on this individual. Seems that it could be a Dr. that disagrees with alternative medicine or even a family member that is unsettled by the thought of medicating with alternative (non-pharma) meds. Either way, my personal experience with triptans was awful. Sure, I got a good 20 to 30 minutes or so of reprieve from the use of the nasal sumatriptan and sometimes with maxalt as well. In the end what sealed the deal with me on triptans was a slowly ramping up cycle where I had believed my neuro that said I absolutely must take the medication at the slightest hint of an attack (I believe this to be true for migraine not so much CH). About a year ago, I did just that and experienced the looongest, worst hit filled cycle of my entire CH career! I hadn't understood the way my CH worked at the time and thought even one spike meant the end of the world as I knew it. Turns out that sometimes I get random spikes then nothing for months after. Since ditching the triptans (knock on wood) I have never experienced anything of that sort again. Do I still keep a few nasal sprays in my purse.. Yep I sure do because if I'm in a critical client meeting where I could stand to loos a project for the company I could use 30 minutes to buy me a close and am willing to suffer to keep the ball rolling at the firm. Anyhow I felt compelled to respond to this as my experience with triptans was so bad that I have road out many a hit without them for the simple fact that I knew in the end I would be better off for it.

... yeah.... he's wrong! .... crap like that is what makes FB such a dangerous minefield for clusterheads... mixed in with that absolutely essential care, compassion and vital info is stuff like this that does a disservice.... especially to the folks new to CH and those w/o the time, desire, ability, means or motivation to go in depth. i mean no disparagement to the many good folk on the many sites... and i'm there too.... but the info is just so scattershot and unreliable it's scary.... with much difficulty checking the bona fides of the poster or researching a topic.... ... the pioneers of busting figured a better way.... the info is right here.... and the Yales and Harvards of the world are finally getting on board.... .... if the anecdotal reports from thousands of clusterheads on the dangers and consequences of overuse (even "proper" use) of triptans isn't enough.... it's right in the medical literature and on the dang label/insert of the script!