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Hi Jimmy, The 240 a day is most likely to low to help much. I am on 480 and take two in the am and two in the pm but I usually have day time attacks. Many on here have mentioned that the rapid release is more effective than the extended. If you are on the ER you may want to talk to your doctor about swapping to RR as it seems like that may be more effective taken in the evening to keep the night attacks at bay.

Wow - can I be your editor??!! This is a very brilliant piece that you have written. Insightful with some really great language. I love the voice - every bit as powerful as the Cluster itself!!! I hope that you are flattered and not offended with my edits below. Your work is great, thank you. "The Mortality Waltz" Wrapped in the deep embrace of unimaginable terror, I waltz through in agony. With every searing neuronal shock, I spin. My screams are like the music as the tears flow. I dance with death to the drumming of my racing heart and the explosive pain in my brain. Stuck in this box step--- 123,123,123--- repeating to myself "re-lease me....re-lease me". Just as the nightmare felt like it would end, leaving a lifeless body, setting me free from this curse. Forevermore with the extinguishing of my heart...the Dance was done. Left was a shell of who I was. Battered beyond repair, a scared quivering woman who's life was run by fear and the anticipation of the next attack. Mortality had released me from our Waltz but not for long as we all well know, it will be back to consume us again.

I tell them I have Clusters, so my assessment of pain levels will reflect that fact.

That's a good question - since this doctor is unlikely to know much of anything about CH or be able to conceptualize pain on a CH scale, I figure your best bet for communicating effectively with such a doc could be to try to go with a 'normal' scale of 1 to 10, not CH 1 to 10.